A Simple Surgical Approach for the Management of Acquired Severe Lower Punctal Stenosis

Sameh S Mandour, Khaled E Said-Ahmed, Hany A Khairy, Moataz F Elsawy, Marwa A Zaky, Sameh S Mandour, Khaled E Said-Ahmed, Hany A Khairy, Moataz F Elsawy, Marwa A Zaky

Abstract

Purpose: Evaluation of using pigtail probe to detect and open severely stenosed lower lacrimal punctum followed by self-retaining bicanalicular intubation.

Study design: A prospective nonrandomized clinical study.

Methods: The study included 24 patients with severe lower punctal stenosis (grade 0 according to Kashkouli scale) attending at Menoufia University Hospitals. The upper punctum and canaliculus were patent. All patients were complaining of epiphora and had a thorough ophthalmological examination including dye disappearance test and slit-lamp examination. Pigtail probe was used from patent upper punctum to detect the lower stenosed punctum which was opened with a scalpel. Syringing of the lower lacrimal passages was done to confirm its patency, and self-retaining silicone bicanalicular stent was inserted. The silicone tube was left in place for 6 months before it was removed. Patients were then followed-up for 1 year after the surgery.

Results: One year after surgery, epiphora was absent (grade 0) in 16 eyes (66.7%) and was present only occasionally (grade 1) in 4 eyes (16.7%). The difference from preoperative epiphora was statistically significant. One year after surgery, fluorescein dye disappearance time was grade 1 (<3 minutes) in 20 cases (83.3%), and grade 2 (3-5 minutes) in 4 cases (16.7%). There was a statistically significant difference compared with preoperative results.

Conclusion: Using the pigtail probe is effective in treatment of severe punctal stenosis. Maintaining the punctal opening and prevention of restenosis can be achieved by using self-retaining bicanalicular stent after confirmation of nasolacrimal duct patency. This trial is registered with NCT03731143.

Figures

Figure 1
Figure 1
(a) Appearance of grade 0 lower punctal stenosis. (b) Using the pigtail probe to detect the stenosed lower punctum. (c) Opening of the lower punctum. (d) Inserting the self-retaining bicanalicular stent through the patent upper punctum and canaliculus. (e) Inserting the self-retaining bicanalicular stent through the patent lower punctum and canaliculus. (f) The final appearance after insertion of the stent.
Figure 2
Figure 2
The self-retaining bicanalicular stent.

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Source: PubMed

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