Evaluation and analysis of tear fluid volume and surgical outcomes for lacrimal punctum obstructive diseases using anterior segment OCT

BACKGROUND: Lacrimal punctum obstructive diseases are a frequent cause of persistent epiphora, leading to discomfort, impaired quality of life, and repeated clinic visits. Accurate and objective assessment of tear dynamics is essential for diagnosis and evaluation of surgical outcomes. OBJECTIVE: To evaluate tear fluid volume using anterior segment optical coherence tomography (AS-OCT) and correlate these objective parameters with surgical outcomes in patients undergoing procedures for punctal obstruction. METHODS: Fifty-two eyes from 34 patients with punctal stenosis or occlusion were evaluated with baseline symptom assessment (Munk score), fluorescein dye disappearance test (FDDT), and AS-OCT imaging of the lower tear meniscus (height, area, volume). Patients underwent snip punctoplastyS, Kelly-punch punctoplasty, or punctal dilatation with intubation. Follow-up assessments were performed at 1, 3, and 6 months postoperatively. RESULTS: AS-OCT imaging demonstrated significant reduction in tear meniscus parameters following surgery. Tear meniscus height decreased from 0.45 ± 0.12 mm to 0.30 ± 0.10 mm, and tear meniscus volume from 0.32 ± 0.15 µL to 0.20 ± 0.10 µL at 6 months (P < 0.001). Symptom burden improved markedly, with median Munk score decreasing from 3 [IQR 2-4] to 1 [0-1]. At 6 months, 82.7% achieved functional success and 88.5% achieved anatomical patency. Reduction in tear meniscus volume correlated strongly with improvement in Munk scores (r = 0.68, P < 0.001). CONCLUSION: AS-OCT provides a rapid, reproducible, and non-invasive method for quantifying tear fluid dynamics. Objective reductions in tear meniscus parameters closely mirror symptomatic and functional improvement, validating AS-OCT as a reliable biomarker of surgical success in punctal obstructive disease.