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.
Highlights
Acquired external punctal stenosis (AEPS) may result from cicatricial conjunctival disease, chemical burn, herpetic viral infection, toxic effects of topical or systemic medications, various infections, eyelid malposition, aggressive lacrimal probing, or different forms of trauma and tumors
After they advanced the pigtail probe back and forth several times, the authors incised the tented area with a scalpel No 11 to make a new punctal opening (Figure 1(c))
Preoperative epiphora was grade 3 in 9 eyes (37.5%) and grade 4 in 15 eyes (62.5%). e preoperative fluorescein dye disappearance test was grade 1 (5 minutes) in 19 eyes (79.2%)
Summary
Acquired external punctal stenosis (AEPS) may result from cicatricial conjunctival disease, chemical burn, herpetic viral infection, toxic effects of topical or systemic medications, various infections, eyelid malposition, aggressive lacrimal probing, or different forms of trauma and tumors. Several procedures have been evolved to treat punctal stenosis [2,3,4,5,6,7,8,9,10]. All depends on the presence of a landmark for the stenosed punctum. It is very difficult to recognize the site of the stenosed punctum which add a considerable challenge to the case. It was used to detect the site of the occluded punctum in a small case series and proved effective [13]
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