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We continue our review of on punctal stenosis by providing a detailed discussion of management modalities, their complications, and outcomes. There is a significant change in the understanding of punctal and peripunctal anatomy, puncto-canalicular junction, and the lacrimal pump mechanisms. While the snip punctoplasty procedures are still practiced, there is an increasing trend toward nonincisional procedures. The nonincisional procedures in select cases appear to be equally effective as the incisional ones. Although simple to use, punctal plugs never became the mainstay of treatment because of design issues and the inability to address the coexisting canalicular stenosis. Placing stents only in the lower punctum in cases of upper and lower punctal stenosis should be discouraged, and management needs to address punctal stenosis and not which punctum is involved. Several types of stents are used in the management of punctal stenosis, mostly based on surgeon's preference. The benefits of adjuvant mitomycin C are uncertain. In view of literature on how stent biofilms can themselves cause chronic inflammation, placing them for prolonged periods should be reviewed and debated. Enhanced understanding of the molecular pathogenesis of punctal stenosis and addressing the current controversies in management would help standardize the therapeutic interventions available in the lacrimal armamentarium. [ABSTRACT FROM AUTHOR]

We aim to provide a detailed and updated literature review on the epidemiology, etiology, clinical presentations, histopathology, and ultrastructural features of punctal stenosis. There are inconsistencies in the definition and staging of punctal stenosis. While advanced optical coherence tomography imaging techniques have revolutionized the way the punctum and vertical canaliculi are assessed or monitored following treatment, the planes of measurement to characterize punctum anatomy need to evolve further. The current criteria for diagnosing and grading punctal stenosis are inadequate and based on empirical clinical findings. There is increasing evidence of the role of lymphocytes and myofibroblasts in the pathogenesis of punctal stenosis. There is a need for a uniform assessment of punctal stenosis and a uniform reporting of severity that would help standardize the several management options available in the lacrimal armamentarium. [ABSTRACT FROM AUTHOR]

To study the efficacy of cyclosporin 0.05% eye drops in the management of grade 1 and 2 acquired punctal stenosis and to compare the results with the clinical outcomes of mini-Monoka insertion. A prospective, controlled, interventional clinical study includes all patients (16 years and older) with symptomatic epiphora and diagnosed with grade 1 or grade 2 acquired punctal stenosis. All patients undergo punctal dilatation, canalicular probing, and nasolacrimal duct irrigation. Afterwards, patients are divided into two groups: Group A: patients receive only medical treatment in the form of topical 0.05% cyclosporin (Restasis®, Allergan Inc.) twice daily for 6 months. Group B: patients receive mini-Monoka stent insertion in the lower canaliculus for 6 weeks. Outcome measures are changes in Munk scoring, grading of the punctum, and functional and anatomical success. Functional success is defined as Munk score 0 to 1 and FDDT grade 0–2. Anatomical success is defined as grade 3 punctum. Forty-two patients are included in the study, with 21 patients in each group. There were no significant differences in the Munk score between the two groups before treatment; however, group B had a significantly higher mean rank at 6 months after treatment. After treatment, the punctal size was significantly larger in group B at 4 weeks and 3 months. However, no significant difference in punctal size was detected at 6 months after treatment between the two groups. Application of cyclosporin 0.05% eye drops is a simple and efficient non-interventional method in the management of grade 1 and 2 acquired punctal stenosis. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to evaluate the prevalence of punctal stenosis in the patients presenting with eye watering due to obstructive epiphora. Patients and methods This descriptive, cross-sectional, prospective study included 75 eyes of 51 patients. The enrolled patients were classified into two groups; group 1 that included patients with punctal stenosis and group 2 that enrolled patients with obstructive epiphora due to other causes. Age subgrouping was performed to determine the prevalence of punctal stenosis among various age groups. Results The mean age of the patients was 52.32±16.19 years. Punctal stenosis was the most encountered cause of obstructive epiphora (32 patients=62.75%) in the study population. Punctal stenosis was also the most prevalent cause of obstructive epiphora (56.3%) in the oldest age subgroup (>60 years). Conclusion Punctal stenosis is the most common cause of obstructive epiphora in patients presenting with eye watering. Increasing age is the most important determinant of punctal stenosis.

Aims To assess the lower lacrimal punctal measurements in patients with punctal stenosis versus normal participants using anterior segment optical coherence tomography (AS-OCT). Patients and methods The study included 39 puncti of 21 healthy asymptomatic volunteers attending the general and oculoplastic outpatient clinics (group I: control group) and 30 puncti of 17 patients with a clinical diagnosis of punctal stenosis defined as the punctal diameter less than 0.3 mm measured by slit-lamp biomicroscopy (group II: cases group). The punctal diameter is measured by slit-lamp biomicroscopy in all participants. The external punctal diameter, the inner punctal diameter at three depths (100, 200, and 500 μm), the punctal depth and tear meniscus height were measured using AS-OCT. Results The internal punctal diameter at 100 μm (239.51±91.14 vs. 168.77±118.07 µm), 200 μm (156.67±75.20 vs. 71.63±76.41 µm), and 500 μm (74.92±60.99 vs. 24.07±34.30 µm) showed statistically significant lower measurements in the cases group compared with the control group. No statistically significant differences were found comparing both groups regarding external punctal diameter otherwise. In the cases group, the punctal diameter measured by slit-lamp biomicroscopy had highly significant statistical evidence of positive correlation with the internal punctal diameter at 200 μm. Conclusion AS-OCT provides a superior ability to assess the patency of the proximal lacrimal drainage system over the routine slit-lamp examination, especially when the internal punctal diameter is measured at a depth of 200 µm. Further research is required to build consensus on standard terminologies, define the standard measurements, and acquire more extensive normative databases. This would mostly be useful in diagnosis of cases of epiphora with externally nonstenosed puncti and distally patent passages.

Aims To assess the lower lacrimal punctal measurements in patients with punctal stenosis versus normal participants using anterior segment optical coherence tomography (AS-OCT). Patients and methods The study included 39 puncti of 21 healthy asymptomatic volunteers attending the general and oculoplastic outpatient clinics (group I: control group) and 30 puncti of 17 patients with a clinical diagnosis of punctal stenosis defined as the punctal diameter less than 0.3 mm measured by slit-lamp biomicroscopy (group II: cases group). The punctal diameter is measured by slit-lamp biomicroscopy in all participants. The external punctal diameter, the inner punctal diameter at three depths (100, 200, and 500 μm), the punctal depth and tear meniscus height were measured using AS-OCT. Results The internal punctal diameter at 100 μm (239.51±91.14 vs. 168.77±118.07 µm), 200 μm (156.67±75.20 vs. 71.63±76.41 µm), and 500 μm (74.92±60.99 vs. 24.07±34.30 µm) showed statistically significant lower measurements in the cases group compared with the control group. No statistically significant differences were found comparing both groups regarding external punctal diameter otherwise. In the cases group, the punctal diameter measured by slit-lamp biomicroscopy had highly significant statistical evidence of positive correlation with the internal punctal diameter at 200 μm. Conclusion AS-OCT provides a superior ability to assess the patency of the proximal lacrimal drainage system over the routine slit-lamp examination, especially when the internal punctal diameter is measured at a depth of 200 µm. Further research is required to build consensus on standard terminologies, define the standard measurements, and acquire more extensive normative databases. This would mostly be useful in diagnosis of cases of epiphora with externally nonstenosed puncti and distally patent passages. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate nasolacrimal drainage and accompanying additional occlusions after topical steroid treatment in punctal stenosis patients with recurrent epiphora. We evaluated the change in nasolacrimal drainage and the effect of the presence of additional pathology on the response to noninvasive medical treatment in the 6-month follow-up after treatment. Materials and Methods: Fifty-two patients with unilateral punctal stenosis and ipsilateral epiphora were included in our study. The mean age of the patients was 68.23±9.67. All patients received topical steroids for punctal stenosis. Dacryoscintigraphy was performed on all patients to evaluate additional pathologies before treatment. In the pre-treatment dacryoscintigraphy, there was obstruction at the lacrimal sac entrance in 7 (13%) patients, at the sac outlet in 24 patients (46%), and in the nasolacrimal duct in 21 patients (40%). Dacryoscintigraphy was repeated 6 months after treatment to evaluate the response to treatment. None of the patients had a history of surgery for the punctum or nasolacrimal system. Ophthalmological examination findings were normal on the non-complaining side. Dacryoscintigraphy on both sides was performed. Scintigraphic images were evaluated both quantitatively and qualitatively. Regions of interest were plotted on specific areas for quantitative evaluation. Results: Thirty-four (81%) patients were female. The punctal region had an edematous appearance in patients with punctal stenosis. Dacryoscintigraphy was repeated 6 months after the treatment to evaluate the response to the treatment. Nasolacrimal drainage was normal in 71% of patients who had stenosis at the entrance and exit of the sac as a result of punctal stenosis treatment. Epiphora and stenosis at the same level persisted in all 21 patients with nasolacrimal duct stenosis. Conclusion: Punctal stenosis is a common condition, especially in elderly patients. Methods with excellent patient compliance in diagnosis and treatment should be preferred first. Dacryoscintigraphy is a convenient method to identify patients for whom aggressive methods are required. [ABSTRACT FROM AUTHOR]

Background Punctal stenosis is a progressive constriction of the puncta with resultant epiphora. One of the most effective treatment options is one- to four-snip punctoplasty with or without mitomycin C (MMC). Aim The aim of this study was to assess the effectiveness of intraoperative MMC in increasing the success rate of three-snip punctoplasty in cases of punctal stenosis. Patients and methods This is a nonrandomized interventional prospective comparative study that was conducted at the Department of Ophthalmology, Al-Hussein and Bab El Sheria Al-Azhar University Hospitals, Cairo, Egypt. It included 31 eyes of 18 patients who underwent three-snip punctoplasty. The patients were divided into two groups: group 1 (15 eyes), in which MMC was not used during surgery, and group 2 (16 eyes), in which MMC was used intraoperatively for 2 min. Complete ocular examinations were performed in all patients using the slit lamp. Punctal stenosis grading was done as follows: grade 0 (absent punctum), grade 1 (a membrane covering the papilla), grade 2 (less than average size, however, can be recognized), grade 3 (normal), grade 4 (small slit

Introduction: The objective of this study was to investigate the prevalence, characteristics, and risk factors of acquired punctal stenosis (APS) in adult patients with allergic conjunctivitis (AC)., Methods: This observational case series study included 210 adult AC patients at Zhongshan Ophthalmic Center. The demographic data were collected, and the ocular manifestations were assessed. Morphologies of AC patients' lacrimal puncta were evaluated and graded using the modified grading system by slit-lamp microscopy., Results: There was 69.0% (145/210) of adult AC participants suffering from APS. Stenotic lacrimal puncta were present in 49.3% (414/840), with grade IIa being the most common (54.6%). Abnormal upper lacrimal puncta were more frequent than lower ones (89.0% vs. 73.1%, p = 0.001). AC patients with APS were significantly older than those without APS (p < 0.001). The percentage of patients with tear meniscus height (TMH) >0.3 mm was 40% in the APS group, compared to 12.5% in the non-APS group (p < 0.001). The age (OR = 1.589, 95% CI: 1.109-2.276, p = 0.012) and TMH (OR = 3.449, 95% CI: 1.224-9.719, p = 0.019) were positively associated with the occurrence of APS., Conclusion: APS, especially the stenosis of upper lacrimal punctum, is frequently observed in the AC patients. Increased age and widened TMH are associated with the prevalence of APS in adult AC patients, suggesting a potential relationship between the long-term and recurrent course of AC and the development of APS., (© 2024 S. Karger AG, Basel.)

Punctoplasty is a common procedure in the management of punctal stenosis and was first described by Sir William Bowman in 1853. Several types of punctoplasty are described, and include 1-snip, 2-snip, triangular 3-snip, rectangular 3-snip and 4-snip procedures. The understanding of the anatomy and physiology of the punctum has greatly improved in the last decade aided by electron microscopic and molecular techniques. The use of minimally invasive modalities for primary cases is on the rise with successful preservation of the physiological functions of the punctum and canaliculus. The paper reviews the current anatomical and physiological evidence to present an alternative perspective. Given our evolving understanding, it may be time to debate the practice of performing routine punctoplasty. [ABSTRACT FROM AUTHOR]

To report a series of patients who developed punctal stenosis secondary to the use of topical netarsudil 0.02% for treatment of glaucoma. Case series. Patients using topical netarsudil for management of glaucoma and noted to have punctal stenosis ipsilateral to the eye(s) being treated with netarsudil were included. Each enrolled patient's chart was reviewed, and alternative causes of punctal stenosis were sought. Photographs were obtained to document punctal stenosis for some patients. Presence of punctal stenosis after topical netarsudil use and resolution of punctal stenosis after cessation of therapy. Sixteen patients had punctal stenosis; 13 developed unilateral punctal stenosis while using netarsudil unilaterally, and 3 patients developed bilateral punctal stenosis with bilateral use. Time from initiation of netarsudil to recognition of symptoms or documentation of punctal stenosis ranged from 2 to 35 months (median, 12; mean, 14.0 ± 8.7 months). Thirteen patients endorsed tearing, but 2 had no symptoms. Ectropion was seen in 1 eye. Corneal verticillata was noted in 14 patients (87.5%). In 8 cases, netarsudil was discontinued, and the punctal stenosis was reversed, with resolution of associated symptoms. Netarsudil use can lead to the development of reversible punctal stenosis. This inflammation-mediated stenosis may cause tearing and associated symptoms and may be of sufficient severity to necessitate discontinuation of treatment. In this case series, all patients who discontinued treatment had reversal of their punctal stenosis and associated symptoms. [ABSTRACT FROM AUTHOR]

Assessment of the efficacy of upper and lower one-snip punctoplasty combined with silicone tube stenting for the management of bi-punctal stenosis. Prospective interventional case series of 20 patients (33 eyes, 66 puncta) with epiphora due to bi-punctal stenosis. All the patients were subjected to bi-punctal 1-snip punctoplasty with silicone intubation, and the tube was kept for 3 months. The follow-up was extended for 6 months after tube removal. The resolution of epiphora with patent puncta was considered as a complete functional success, while patent puncta with residual epiphora were considered as an anatomical success. The mean patients' age was 41.3 years and 55% were females. Grade 0 puncta were found in 9.1%, and grade 1 represented 39.4%, while 51.5% had grade 2 puncta. Silicone tube was removed after an average period of 12.1 ± 2.7 weeks. Complete functional success was reported in 90.9% while anatomical success was noticed in 97%. One-snip punctoplasty combined with 3 months of silicone intubation can be considered in the management of bi-punctal stenosis achieving high success rates with a minor discrepancy between functional and anatomical outcomes. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to evaluate the efficacy of combining mitomycin-C (MMC) with modified rectangular 3-snip punctoplasty and mini-Monoka stent to treat punctal stenosis. Design This is a prospective interventional case series. Patients and methods The study included 62 eyes of 31 patients diagnosed with epiphora secondary to punctal stenosis who received modified rectangular 3-snip punctoplasty with mini-Monoka stent and MMC in their right eyes (Rt eye group) and modified rectangular 3-snip punctoplasty with mini-Monoka stent only in their left eyes (Lt eye group). Epiphora, punctal opening, and tear meniscus height (TMH) were evaluated and compared with the preoperative data in both groups. The main outcome measures were epiphora, punctal opening, and TMH. Results A total of 17 (54.8%) patients were females, with a mean age of 58.4±5.1 years. No surgical complications were reported. Epiphora and TMH were improved, with a functional success of 90.3% in the Rt eye group and 87.1% in the Lt eye group, as compared with the preoperative status (P

Several chemotherapeutic agents are known to induce lacrimal drainage stenosis and obstruction, resulting in epiphora. Pemetrexed is one such drug and is used in the management of mesotheliomas and non-small cell lung carcinomas. Pemetrexed inhibits folate metabolism at multiple levels. The present case is the second report of pemetrexed induced punctal and canalicular stenosis, but the first to document dacryoendoscopy findings and report balloon puncto-canaliculoplasty as a minimally-invasive treatment option. [ABSTRACT FROM AUTHOR]

Sarah W DeParis,1,2 Clarinda J Hougen,1 Fatemeh Rajaii,1 Nicholas R Mahoney1 1Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA; 2Department of Ophthalmology, The Permanente Medical Group, San Rafael, CA, USACorrespondence: Nicholas R MahoneyDepartment of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USATel +1 410 955 1112Fax +1 410 614 9987Email nick.mahoney@jhmi.eduPurpose: The Kaneka Lacriflow CL (Lacriflow) bicanalicular lacrimal intubation system was evaluated as a self-retaining alternative to traditional modalities for stenting and dilation of the lacrimal drainage system in proximal lacrimal drainage system stenosis.Patients and Methods: A retrospective chart review was conducted to assess the use of the Lacriflow system for treatment of patients with punctal and canalicular stenosis. Anesthesia type, operative time, and complications were assessed.Results: In the time period evaluated, a total of 72 Lacriflow stents were placed in 45 patients, most commonly under intravenous sedation. Stents were left in place for a mean of 145 days, with 9 stents left in place for more than 1 year, and a mean follow-up time of 263 days. Early complications within 90 days included prolapse in 1 stent, symptomatic colonization for 2 stents, and corneal abrasion in 1 stent in a patient with anterior basement membrane dystrophy. Five additional stents developed colonization in the late postoperative period (four of which were more than 1 year after stent placement). The overall complication rate (per stent) at 3 months after surgery was 5.6% and at all follow-up time points was 13.9%. Operative times were significantly shorter for a cohort of patients undergoing bicanalicular intubation with the Ritleng system (P = 0.015).Conclusion: The Lacriflow bicanalicular stent can be easily placed without general anesthesia. Complication rates are comparable to other bicanalicular intubation systems, but increase with longer time that stents are left in place.Keywords: bicanalicular intubation, canalicular stenosis, punctal stenosis, Lacriflow, silicone intubation

In this case series, the authors report three patients with severe atopic dermatitis who presented with epiphora and conjunctivitis while undergoing dupilumab therapy. On clinical examination, all patients were found to have punctal stenosis, with one case having progressed to punctal obstruction. An assortment of strategies was elected, including discontinuation of dupilumab, treatment of conjunctivitis, and surgical intervention with probing, punctoplasty, and silicone intubation. This report spotlights punctal stenosis as an important new side effect of dupilumab and suggests that additional cases of dupilumab-associated lacrimal drainage impairment will continue to emerge. [ABSTRACT FROM AUTHOR]

Objectives: This was an assessment of one-snip punctoplasty outcomes in patients for whom adjunctive punctal re-dilatation was performed in-office for early postoperative cicatricial changes. Methods: A retrospective analysis was conducted of patients who underwent one-snip punctoplasty between March 2019 and February 2020 due to acquired punctal stenosis. Patients were followed up on the first, third, and seventh postoperative day, then weekly for the remainder of the first month, every 2 weeks over the next month, and then monthly. Punctal re-dilatation was performed if patients showed early clinical signs of re-stenosis. Demographic details, the number and timing of re-dilatation procedures, the timing of re-stenosis, and anatomical and functional success rates were analyzed. Results: The medical records of 148 eyes of 86 patients were evaluated. A re-dilation procedure was performed in a total of 57 (38.5%) puncta showing signs of early cicatrization. The first punctal re-dilatation was performed at a mean of I7.2±ll.3 days (range: 3-57 days). Re-stenosis was observed in 25 puncta (16.9%) at a mean of 5.6±3.l weeks (range: 2-16 weeks). The anatomical success rate was 83.1% and the functional success rate was 79.1%. There were no significant differences in the anatomical and functional success rates between the patients who did and did not need adjunctive re-dilatation. Conclusion: In-office punctal re-dilatation may improve functional and anatomical success rates after one-snip punctoplasty by preventing recurrent punctal cicatrization. [ABSTRACT FROM AUTHOR]

Purpose: To identify a rationale for correct surgical treatment of proximal lacrimal obstructions. Methods: Retrospective review of 775 consecutive patients (974 eyes) with proximal lacrimal obstructions, operated on with customized surgery by a senior surgeon (FMQL) from January 2003 to December 2018. Results: In case of punctal stenosis, punctoplasty was as effective as punctal dilatation with monocanalicular or bicanalicular stent (p > 0.05). In proximal canalicular obstructions, failure rate of dacrocystorhinostomy with retrograde intubation (R‐DCR) was significantly higher in case of false inferior passage creation than in case of no false passage creation (p = 0.02). In mid‐canalicular obstructions failure rate of R‐DCR was 41.3%, and bypass surgery with Jones tube at second stage was likely. Trephination and monocanalicular intubation, performed in selected cases, had a failure rate respectively of 16.6% and 21.7% in mid and distal canalicular obstructions. Canaliculodacryocystorhinostomy (CDCR) was successful in 77% of cases of proximal common canalicular obstruction. Bypass surgery is the treatment of choice in case of no residual patency, and rates of tube extrusion were significantly reduced with the use of StopLoss Jones tubes (SLJT) (1.7%) with respect to standard tubes (12%), (p = 0.04, Fisher's exact test). Conclusion: Patient history and accurate diagnosis of the site of obstruction are essential for a correct surgical choice. Less invasive techniques as trephination and intubation may be effective, but should be reserved to patients with no associated lower lacrimal obstruction. Further studies require specific randomized clinical trials, and a standardized protocol adopted by different clinical centres. [ABSTRACT FROM AUTHOR]

Purpose: This study explores the relationship between acquired punctal stenosis (PS) and ocular surface disease (OSD), assessing causal mechanisms and clinical impacts, utilizing a combination of a comprehensive literature review and a detailed analysis of a patient cohort from a tertiary care center., Methods: Data from 213 PS patients at Sheba Medical Center were retrospectively analyzed, evaluating various OSD symptoms and treatment effectiveness through standardized clinical assessments and statistical tests., Results: Predominantly older and female, many patients exhibited bilateral PS. OSD symptoms were found in 35.2% of all patients. Treatments like punctoplasty with stents significantly alleviated symptoms. Significant associations between treatment modalities and symptom improvement were identified., Conclusions: PS and OSD have acomplex, bidirectional relationship that complicates treatment outcomes. This study underscores the need for thorough diagnostic approaches and personalized treatments to improve PS management. Further research is essential to deepen understanding of PS-OSD interactions and develop effective therapies.

Purpose: To evaluate the results of using a pigtail probe to open the inferior punctum followed by bicanalicular silicone tube intubation in patients with severe acquired punctal stenosis., Methods: Forty-one eyes of 25 patients with severe inferior punctal stenosis admitted to our tertiary care center were included in the study. The degree of epiphora was determined using the Munk score and the fluorescein disappearance test. The inferior punctum was located and opened by entering the superior punctum with a pigtail probe. Then, bicanalicular silicone tube intubation was performed. The silicone tube was removed after six months. A Munk score of 0 or 1 and a fluorescein disappearance test score of 1 and 2 were considered a complete success., Results: Ten (40%) patients were male, and 15 (60%) were female. The mean age was 60.4±15.5years. One year after the surgery, epiphora was absent in 18 eyes (43.9%) (Munk score grade 0) and rarely seen in 9 eyes (22%) (Munk score grade 1). At the one-year follow-up, the fluorescein disappearance test score was stage 1 (<3min) in 21 eyes (51.2%) and stage 2 (3-5min) in 13 eyes (31.7%). There was a statistically significant difference between the preoperative and one-year postoperative test results (P<0.001)., Conclusion: In cases with severe punctal stenosis, a pigtail probe is an effective method for locating and opening the punctum, and punctal opening and prevention of restenosis were achieved by a bicanalicular stent., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Abstract Background We developed a novel surgical technique to treat punctal stenosis involving the placement of three interrupted sutures after rectangular three-snip punctoplasty (TSP). Methods Retrospective chart review of forty-eight eyes of 44 patients who underwent rectangular TSP with three interrupted sutures was performed. We investigated whether anatomical recurrences (re-stenosis) occurred during the follow-up period. The subjective symptoms of patients were surveyed. Results The mean patient age was 64.1 years, and the mean follow-up time was 17.4 months. The placement of three interrupted sutures after rectangular TSP afforded satisfactory outcomes. Regarding subjective symptoms, 91.7% of the eyes (44/48) were reported as improved. Among 4 eyes determined as symptomatic failure, anatomical recurrence (re-stenosis of the punctum) was observed in only one eye. The other three (6.25%, 3/48 eyes) showed functional nasolacrimal obstruction, namely epiphora with patent tear duct. Conclusions Placement of three interrupted sutures after rectangular TSP to treat punctal stenosis showed promising results. Notably anatomical success rate was about 98%. Further comparisons between the novel surgical technique and conventional techniques are required.

Purpose: The objective of this study was to assess the quality of outcomes of mini-Monoka stent dilatation for punctal stenosis using the lacrimal symptom (Lac-Q) questionnaire. Methods: Prospective interventional case series of 45 eyes of 25 consecutive patients who underwent mini-Monoka stent dilatation for primary punctal stenosis were included in the study. The stents were extubated at 4 weeks. The Lac-Q questionnaire was administered preoperatively and at 12 weeks and 24 weeks following the intervention. Outcomes assessed were anatomical success, functional success, and changes in the questionnaire scores including total, social impact, and lacrimal symptom scores. Statistical analysis was performed using the Wilcoxon signed-rank test, and the probability of obtaining a certain score was calculated using the multinomial log-linear model. P < 0.05 was considered as significant. Results: Monoka stents were performed for 45 eyes. A total of 75 questionnaire responses were analyzed. At the last follow-up of 24 weeks, the anatomical and functional success rates were 93.3% (42/45). The changes in the mean total score (7.68 preoperatively to 0.82 at 24-week follow-up) were statistically significant (P ≤ 0.001). The mean social impact scores showed significant improvement postoperatively from 4.06 to 0.53 (P ≤ 0.001). The mean lacrimal symptom score changed from a preoperative value of 3.62 to 0.28 (P ≤ 0.001) at the last follow-up. Postoperative scoring correlated well with the anatomical and functional success rates. The symptom scores corroborated with changes in the clinical outcomes. Conclusion: Mini-Monoka stent dilatation is a very effective intervention for the management of primary punctal stenosis, and Lac-Q questionnaire is a simple and useful tool to evaluate the quality of outcomes in such cases.

Purpose: To assess the effectiveness of mini-monoka (MM) stenting in treating patients with perennial allergic conjunctivitis (PAC) and punctal stenosis. Methods: A retrospective case analysis was performed on 20 patients (40 eyes) who suffered from PAC with punctal stenosis who underwent MM (FCI Ophthalmics, Pembroke, MA, USA) stenting. Results: Nineteen patients (95%) were females, with an age range of 19–66 years (average 40.6 ± 25.4 years). All 20 patients (100% of eyes) had signs of PAC and punctal stenosis. All 20 patients (40 eyes) had received previous topical treatment including steroids. Nineteen patients (95% of eyes) had significant improvement in their allergy symptoms (tearing and conjunctival inflammation) following MM stenting. Conclusions: Stenosis of the punctum may play a role in the relapsing symptoms in PAC. MM stenting is a simple, safe, effective, and relatively non-invasive treatment option for the management of PAC in the presence of punctal stenosis. [ABSTRACT FROM AUTHOR]

Six dogs were diagnosed with punctal stenosis following the long‐term use of topical neomycin‐polymyxin B‐dexamethasone (NPD). All patients were initially presented for ophthalmic diseases requiring ongoing anti‐inflammatory therapy. Five of the 6 dogs had previously or concurrently been treated with topical anti‐inflammatory medications other than NPD. One patient exclusively received topical NPD prior to the diagnosis of punctal stenosis. The onset of punctal stenosis following therapy with NPD was variable among patients, ranging from 4 months to over 1 year. Diagnosis of punctal stenosis was made based upon the presence of epiphora and visualization of fibrotic tissue over the nasolacrimal puncta. [ABSTRACT FROM AUTHOR]

AIM: To investigate the feasibility and clinical effect of punctoplasty by using trabeculectomy punch combined with a novel RS tube for the treatment of punctal stenosis.METHODS: Totally 39 patients(39 eyes)with punctual stenosis were selected from October 2013 to October 2015 in the Second People's Hospital of Foshan. All patients underwent punctoplasty by using trabeculectomy punch combined with a novel RS tube. These tubes were removed at 3mo after operation. A follow-up of 6mo was taken for final analysis. The fluorescein dye disappearance test score was recorded before the operation and at 1,3 and 6mo after the extubation. The curative effect of the operation at 6mo after the extubation was assess. RESULTS: Fluorescein dye disappearance test: the scores at 1,3 and 6mo after the extubation all decreased compared with the preoperative ones. The difference was statistically significant(PCONCLUSION: Punctoplasty by using trabeculectomy punch combined with novel RS tubes is a safe and effective method for the punctul stenosis, which is easy to perform, with high success rate.

Optical Coherence Tomography (OCT) is a safe and non-invasive method of high-resolution cross-sectional imaging of tissue microstructures using infrared radiation. This study investigates how the appearance of the punctum and proximal canaliculus differs pre- and post-operatively in patients undergoing punctoplasty surgery. Patients with symptomatic punctal stenosis warranting punctoplasty surgery were prospectively invited to enrol from a single centre. Spectral OCT images of the lower punctae were captured with a Topcon 3D OCT 2000 machine pre- and post-operatively (at their follow-up appointment). Measurements were made of the maximal punctal diameter, canalicular diameter and canalicular depth. Pre- and post-operative measurements were compared using a pairedt-test. Twenty-three punctae of 18 patients with punctal stenosis were included in the study. They were 10 males and 8 females with a median age 71.0 (SD 12.1). Mean canalicular cross-sectional area was 56.9 × 10-3 mm2pre-operatively and 267.2 × 10-3 mm2post-operatively, showing a statistically significant increase (p= 0.0004). There was an increase in both mean canalicular width (0.253 to 0.524mm (p= 0.0001)) and depth (0.433 to 0.852mm (p= 0.0001)) from pre- to post-operatively. There was a significant improvement in symptoms from pre- to post-operatively, as measured subjectively by the Lac-Q questionnaire (p= 0.021). This study describes the change in the appearance of the punctum and proximal canaliculus in patients undergoing punctoplasty operations, by using spectral OCT to capture in vivo high-resolution images. It demonstrates that punctal OCT can be successfully applied to quantify the morphological changes of the punctum and canaliculus pre- and post-punctoplasty. [ABSTRACT FROM PUBLISHER]

Purpose: The objective of this study was to assess the quality of outcomes of mini-Monoka stent dilatation for punctal stenosis using the lacrimal symptom (Lac-Q) questionnaire.Methods: Prospective interventional case series of 45 eyes of 25 consecutive patients who underwent mini-Monoka stent dilatation for primary punctal stenosis were included in the study. The stents were extubated at 4 weeks. The Lac-Q questionnaire was administered preoperatively and at 12 weeks and 24 weeks following the intervention. Outcomes assessed were anatomical success, functional success, and changes in the questionnaire scores including total, social impact, and lacrimal symptom scores. Statistical analysis was performed using the Wilcoxon signed-rank test, and the probability of obtaining a certain score was calculated using the multinomial log-linear model. P < 0.05 was considered as significant.Results: Monoka stents were performed for 45 eyes. A total of 75 questionnaire responses were analyzed. At the last follow-up of 24 weeks, the anatomical and functional success rates were 93.3% (42/45). The changes in the mean total score (7.68 preoperatively to 0.82 at 24-week follow-up) were statistically significant (P ≤ 0.001). The mean social impact scores showed significant improvement postoperatively from 4.06 to 0.53 (P ≤ 0.001). The mean lacrimal symptom score changed from a preoperative value of 3.62 to 0.28 (P ≤ 0.001) at the last follow-up. Postoperative scoring correlated well with the anatomical and functional success rates. The symptom scores corroborated with changes in the clinical outcomes.Conclusion: Mini-Monoka stent dilatation is a very effective intervention for the management of primary punctal stenosis, and Lac-Q questionnaire is a simple and useful tool to evaluate the quality of outcomes in such cases. [ABSTRACT FROM AUTHOR]