Treatment of upper and lower lacrimal punctal occlusion using retrograde canaliculotomy and punctoplasty

This is a retrospective, noncomparative analysis of a case series to explore the safety and effectiveness of retrograde canaliculotomy and punctoplasty for treating epiphora due to upper and lower lacrimal punctal occlusion. During the procedure, the horizontal portion of the normal lower canaliculus was identified;the corresponding punctum was reconstructed via retrograde canaliculotomy and punctoplasty. Intubation was performed to prevent postoperative reocclusion. Patients were followed up for 12 to 24 mo. A total of 16 patients with unilateral upper and lower lacrimal punctal occlusion were included. Satisfactory outcomes were achieved: all 16 patients exhibited improvement of epiphora;31 rebuilt punctal openings and canaliculi achieved recanalization. Only one upper punctal opening could not be reconstructed because the corresponding canaliculus exhibited severe injury. No significant complications occurred as a result of the treatments. Retrograde canaliculotomy and punctoplasty appears to effective, safe, and minimally invasive for treatment of upper and lower punctal occlusion.

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.