Punctal stenosis: definition, diagnosis, and treatment

Uri Soiberman, Hirohiko Kakizaki, Dinesh Selva, Igal Leibovitch, Uri Soiberman, Hirohiko Kakizaki, Dinesh Selva, Igal Leibovitch

Abstract

Acquired punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded. This condition is a rare cause of symptomatic epiphora, but its incidence may be higher in patients with chronic blepharitis, in those treated with various topical medications, including antihypertensive agents, and especially in patients treated with taxanes for cancer. The purpose of this review is to cover the medical literature, focusing in particular on definition, incidence, risk factors, etiology and treatment options.

Keywords: acquired punctal stenosis; definition; epiphora; etiology; treatment.

Figures

Figure 1
Figure 1
The puncti are positioned medially, near the medial canthus. They are located within the papillae. This complex opens into the tear layer. The tears are collected through the puncti and into the canaliculi.
Figure 2
Figure 2
Jones’ one-snip punctoplasty. A vertical incision is made along the ampulla.
Figure 3
Figure 3
Three-snip punctoplasty. A vertical incision is made down the ampulla. A horizontal incision is then made along the canaliculus. A last incision made along the base of the free flap opposing the bulbar conjunctiva creates a triangular-shaped broadened punctum.
Figure 4
Figure 4
Two-snip punctoplasty. A vertical cut is made in the medial wall of the punctum and then in the lateral wall. The flap remaining is incised at its base.

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