Abstract:

Objective To assess the etiology and surgery effectiveness of the acquired punctal stenosis. Design Prospective case series. Participants Sixty-one eyes of 40 patients presenting with epiphora who were diagnosed as acquired punctal stenosis and underwent surgical management from January 2016 to March 2017 were assessed. Female accounted for 83% and the mean age was 54±13.3 years. Methods The severity of the stenosis was graded based on slit-lamp examination according to Kashkouli’s method. Grade 0 is no papilla and punctum,  Grade 1 is papilla covered by a membrane or fibrosis and difficult to recognize,  Grade 2 is less than normal size but recognizable,  and Grade 3 is normal. Sequential punctal dilation combined with Ritleng silicone intubation was performed in grading 0~2 of punctal opening size. A 25-G needle was used to open the papilla and then progressively larger dilators were used to dilate the ampulla to introduce a Ritleng probe. Anatomical success was defined as a well-patent puncta (Grade 3-5) and functional success as Munk epiphora scoring ≤1 and negative fluorescein dye disappearance test (FDDT) at 6 months after removal of silicone stents. Main Outcome Measures Punctal grading,  Munk scoring,  and FDDT. Results Twenty-one cases (53%) were bilateral and both upper and lower puncta were involved in 40 eyes (66%). Thirty-one cases (78%) were idiopathic without any known causes. The mean pre-operative and post-operative punctal grading was 1.3±0.7 and 3.0±0.4 respectively with statistically significance (p<0.001). Anatomical success rate was 94% (95/101) and functional success rate was 92% (56/61). No serious complication was noted except for mild punctal laceration in 2 eyes. Conclusion The most common underlying cause for acquired punctual stenosis was idiopathic involutional change in this series. Sequential punctal dilation with Ritleng intubation is a safe and efficient technique in the management of acquired punctal stenosis.

Key words: acquired punctal stenosis, etiology, punctoplasty, silicone intubation