Rectangular 3-snip punctoplasty versus punch punctoplasty with silicone intubation for acquired external punctal stenosis:a prospective randomized comparative study

AIM:To evaluate the effectiveness of rectangular 3-snip punctoplasty versus punch punctoplasty via Kelly punch with silicone intubation for the management of acquired external punctal stenosis(AEPS).METHODS:A prospective,randomized,comparative study was performed on 123 eyes of 94 patients with AEPS.Patients were recruited into either group of rectangular 3-snip punctoplasty(group A)or group of punch punctoplasty with silicone intubation(group B).Outcomes measured were Munk score,grade of punctal stenosis,fluorescein dye disappearance time test(FDDT)and tear meniscus height(TMH)6 and 12 mo after surgery.RESULTS:Twelve months after surgery,Munk score,FDDT and TMH significantly decreased in both groups compared with the baseline(all P<0.05),and grade of punctal stenosis increased significantly(P<0.05).The grade of punctal stenosis,Munk score,FDDT and TMH were better in group B compared with group A at 6 or 12 mo(all P<0.05).There was a positive correlation between TMH and Munk score(R=0.655,P<0.001).At the last followed-up,anatomical success was noted in 96.7%eyes in group A and 98.4%eyes in group B(P=0.613).CONCLUSION:Punch punctoplasty via Kelly punch with silicone intubation achieves better outcomes than rectangular 3-snip punctoplasty.The new technique is a simple,minimally invasive,with high anatomical and functional success in patients with AEPS.

Topical Cyclosporine-A for Management of Epiphora in Eyes with Acquired Punctal Stenosis

Background: Cyclosporine A (CsA) is an inhibitor of calcineurin that prevents T-cell production of inflammatory cytokines and disrupts the immune-mediated inflammatory response that plays a crucial mechanism in punctal stenosis. Purpose: To evaluate the clinical outcomes and tolerances of CsA in treating epiphora in eyes with punctal stenosis. Study Design: Prospective study. Methods: The study included patients who presented with symptomatic epiphora associated with lower punctal stenosis during the period between July 2019 and December 2020. Patients were treated with topical 0.05% CsA on twice daily dose with topical preservative-free artificial tears Q.I. D. Patients were followed up monthly for at least 3 months by Munk epiphora grading, Fluorescein dye disappearance test (FDT) and evaluation of the patient satisfaction. Results: A total of 26 patients with 47 eyes were included in the study with a mean age of 55.1 ± 10.24 years. All the eyes had grade 0 lower punctal stenosis with grade 4 on Munk grading and grade 3 in FDT. There was a statistically significant difference in the Munk grading and FDT along the follow-up period compared to the baseline values (p Conclusion: CsA can control the inflammation of the conjunctival sac and restore the integrity of the ocular surface with subsequent symptomatic relief of the epiphora in eyes with punctal stenosis.