Incomplete punctal canalization -a balloon variant of the external membrane: a case report

INTRODUCTION: Incomplete punctal canalization is an uncommon congenital disorder characterized by a dysgenetic punctum with membranes. External membranes, the most common type of incomplete punctal canalization are flat and overlie the punctum as a veil. We describe a newer variant of incomplete punctal canalization, its clinical profile, diagnostic criteria and management. CASE PRESENTATION: A 9-year-old Indian boy presented with watering of his right eye since birth. His right eye lower punctal area showed an avascular translucent elevation that appeared to have a smooth dome shape. An examination at high magnification showed the slopes of the dome gradually merging and contiguous with the tarsal conjunctiva. Based on a very high degree of suspicion, an impression of atypical external membrane variety of incomplete punctal canalization was made. Membranotomy was successful in the management of his condition. CONCLUSIONS: A high degree of suspicion is the key point in the diagnosis of this variant, keeping in mind the other features described for incomplete punctal canalization- external membrane. It is possible that ballooning of these membranes may represent an evolutionary stage in the process of complete canalization and this could be the starting point for further dacryo-embryologic exploration and correlations.