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Advances in Medicine
Volume 2014, Article ID 809851, 4 pages
Clinical Study

Presumed Virus-Induced Punctal Occlusion

1Department of Ophthalmology, Ziv Medical Center, Safed, Israel
2Bar-Ilan Faculty of Medicine, Safed, Israel

Received 4 May 2014; Revised 20 October 2014; Accepted 26 October 2014; Published 13 November 2014

Academic Editor: Xinhua Shu

Copyright © 2014 Michael Yulish and Joseph Pikkel. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. To investigate viral infection as a cause of punctal stenosis in individuals without any ocular or systemic risk factors. Methods. The study group comprised patients with no known cause for punctal occlusion who underwent surgery at one medical center during a one-year period. Excised tissue was subjected to histological examination, PCR, and nested PCR testing for common viruses (adenovirus, influenza A and B, enterovirus, varicella-zoster, CMV, herpes simplex types 1 and 2, Epstein-Barr virus, and parainfluenza type 1). Results. All nine patients identified were female, 20–38 years of age. The three-snip-procedure resolved tearing in eight of them. All excised samples showed chronic mononuclear inflammation compatible with viral infection or with viral infection immune inflammatory reaction. PCR testing was negative for all the viruses examined; however, nested PCR was positive in three patients. Conclusion. This study supports the proposition that punctal occlusion in young healthy females may be due to viral infection.