Histopathology, Immunohistochemistry, and Electron Microscopy of the Medial Canthal Tendons in Centurion Syndrome and Description of a new “Needle Head Sign”
- 1Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
Abstract
Purpose:: To describe a new diagnostic clinical feature—the “needle head sign” along with histopathology, immunohistochemistry, and electron microscopy of the medial canthal tendon in patients with Centurion syndrome (CS).
Methods:: Retrospective review of all cases diagnosed with CS and having external and closed eye photographs in their electronic medical records. Patients with missing or inappropriate photographs or those who had prior surgical interventions were excluded from the analysis. Data collected included demographics, history, presenting complaints, external and ocular examination, lacrimal examination, including the tear meniscus height, fluorescein dye disappearance test, and lacrimal irrigation. Photographs were reviewed for all signs of CS, along with the additionally described “needle head sign” for diagnosis of CS. Medial canthal tendons from patients with CS who underwent surgical intervention and normal tendon from a patient undergoing dacryocystectomy were obtained for histopathological analysis.
Results:: 28 eyes of 14 patients with complete documentation were included for the analysis. Males (n=13, 92.86%) were more affected and the average age at presentation was 17 years (range= 5-32 years). Epiphora was the universal symptom and was present for an average duration of 43.06 months. Anterior placement of the medial canthal tendon and beak sign were universal (100%), followed by prominent nasal bridge in 92.86% (26 eyes), punctal dystopia in 82.14% (23 eyes) synophrys in 7.14% (2 eyes), epicanthal fold in 7.14% (2 eyes), ptosis in 3.57% (1 eye), lagophthalmos in 7.14% (2 eyes), and punctal agenesis in 1 eye of 1 patient (3.57%). The “needle head sign” was seen in 21 eyes of 14 patients (75%), bilateral in 64.28% (9 patients), unilateral in 21.43% (3 patients) and absent in 7 eyes of 5 patients (25%). The fluorescein dye disappearance test performed showed delay of >5 minutes in 21 eyes of 11 patients (95.45%). Tear meniscus height was raised in 25 eyes of 14 patients (89.29%). Irrigation was patent in all eyes. Histopathology and electron microscopy showed morphological changes in the tendons.
Conclusion:: The “needle head sign” is an additional sign that can be of adjunct value in the diagnosis of CS. The medial canthal tendons of CS demonstrate certain histopathological and ultrastructural changes, which need further evaluation.
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BibTeX
@article{bothra2026histopathology,
title = {{Histopathology, Immunohistochemistry, and Electron Microscopy of the Medial Canthal Tendons in Centurion Syndrome and Description of a new “Needle Head Sign”}},
author = {Nandini Bothra and Anannya Abhyankar and Mohammad Javed Ali},
journal = {Ophthalmic Plastic and Reconstructive Surgery},
year = {2026},
month = may,
doi = {10.1097/iop.0000000000003234},
url = {https://doi.org/10.1097/iop.0000000000003234},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Histopathology, Immunohistochemistry, and Electron Microscopy of the Medial Canthal Tendons in Centurion Syndrome and Description of a new “Needle Head Sign”
AU - Nandini Bothra
AU - Anannya Abhyankar
AU - Mohammad Javed Ali
PY - 2026
DA - 2026/05/26
JO - Ophthalmic Plastic and Reconstructive Surgery
DO - 10.1097/iop.0000000000003234
UR - https://doi.org/10.1097/iop.0000000000003234
AB - Purpose:: To describe a new diagnostic clinical feature—the “needle head sign” along with histopathology, immunohistochemistry, and electron microscopy of the medial canthal tendon in patients with Centurion syndrome (CS). Methods:: Retrospective review of all cases diagnosed with CS and having external and closed eye photographs in their electronic medical records. Patients with missing or inappropriate photographs or those who had prior surgical interventions were excluded from the analysis. Data collected included demographics, history, presenting complaints, external and ocular examination, lacrimal examination, including the tear meniscus height, fluorescein dye disappearance test, and lacrimal irrigation. Photographs were reviewed for all signs of CS, along with the additionally described “needle head sign” for diagnosis of CS. Medial canthal tendons from patients with CS who underwent surgical intervention and normal tendon from a patient undergoing dacryocystectomy were obtained for histopathological analysis. Results:: 28 eyes of 14 patients with complete documentation were included for the analysis. Males (n=13, 92.86%) were more affected and the average age at presentation was 17 years (range= 5-32 years). Epiphora was the universal symptom and was present for an average duration of 43.06 months. Anterior placement of the medial canthal tendon and beak sign were universal (100%), followed by prominent nasal bridge in 92.86% (26 eyes), punctal dystopia in 82.14% (23 eyes) synophrys in 7.14% (2 eyes), epicanthal fold in 7.14% (2 eyes), ptosis in 3.57% (1 eye), lagophthalmos in 7.14% (2 eyes), and punctal agenesis in 1 eye of 1 patient (3.57%). The “needle head sign” was seen in 21 eyes of 14 patients (75%), bilateral in 64.28% (9 patients), unilateral in 21.43% (3 patients) and absent in 7 eyes of 5 patients (25%). The fluorescein dye disappearance test performed showed delay of >5 minutes in 21 eyes of 11 patients (95.45%). Tear meniscus height was raised in 25 eyes of 14 patients (89.29%). Irrigation was patent in all eyes. Histopathology and electron microscopy showed morphological changes in the tendons. Conclusion:: The “needle head sign” is an additional sign that can be of adjunct value in the diagnosis of CS. The medial canthal tendons of CS demonstrate certain histopathological and ultrastructural changes, which need further evaluation.
SN - 0740-9303
SN - 1537-2677
ER -