Punctal Stenosis Research Articles

Prevalence, Clinical Characteristics, and Relative Factors of Acquired Punctal Stenosis in Adult Allergic Conjunctivitis Patients

Plain Language SummaryThis study aimed to examine the prevalence of acquired punctal stenosis (APS) among adults with allergic conjunctivitis (AC), describe its characteristics, and identify associated risk factors. We reviewed the medical data of 210 adult patients with AC at Zhongshan Ophthalmic Center. We gathered demographic data and evaluated ocular symptoms. Using slit-lamp microscopy, we assessed and graded the morphology of the lacrimal puncta (lacrimal duct openings) according to a modified grading system. The study results revealed that 69% of the adult patients with AC had APS. Stenotic lacrimal puncta were present in 49.3%, with grade IIa being the most common. The narrowing was most frequently observed in the upper lacrimal puncta compared to the lower ones. Older age and a higher tear meniscus height (TMH) were significantly associated with the presence of APS. Therefore, this study demonstrates that APS is commonly observed in adults with AC, which is associated with the increased age and widened TMH, indicating a possible link between chronic and recurrent AC and the development of APS.

Comparison of preoperative and postoperative results of "canalicular triangular flap" and "triangular three-snip" punctoplasty techniques in patients with punctum stenosis using anterior segment optical coherence tomography.

To compare the results and success rates of patients with epiphora due to punctal stenosis operated with the "canalicular triangular flap punctoplasty" and the "triangular three -snip punctoplasty" using anterior segment optical coherence tomography (AS-OCT). This study is a retrospective cohort analysis of patients who were diagnosed with punctal stenosis and underwent canalicular triangular flap or triangular three-snip punctoplasty between September 2021 and June 2022. The study included 80 eyes of 43 patients consisting of 15 males and 28 females. Forty eyes underwent canalicular triangular flap punctoplasty (Group A) and 40 eyes underwent triangular three-snip punctoplasty (Group B) technique. The mean age of the patients was 63.9 ± 10.9 years (37-88 years). In Group A, the anatomic success was 100% and functional success was 95% at 6 months. In Group B, 77.5% functional success and 75% anatomic success were achieved at 6 months. The canalicular triangular flap technique was more successful in providing punctal patency both anatomically and functionally than the triangular three-snip punctoplasty. AS-OCT is a method that provides objective, quantitative results in the diagnosis and follow-up of punctal stenosis and may be used more widely in punctum and vertical canaliculi pathologies.

Ocular effects of Rho kinase (ROCK) inhibition: a systematic review.

Topical therapies targeting Rho-associated protein kinase (ROCK) signalling, including netarsudil (Rhopressa®) and ripasudil (Glanatec®), have become widely adopted as part of standard clinical practice to lower intraocular pressure (IOP) in patients with ocular hypertension or glaucoma. Given the pleiotropic roles of ROCK signalling, ROCK inhibition has the potential to cause unintended ocular side effects beyond IOP lowering in other substructures of the eye, both beneficial and deleterious. Additional experience and observation of patients treated with this class of medications have uncovered both new side effects not reported in the initial clinical trials, as well as potential benefits that have inspired off-label uses and that have been the topic of numerous clinical studies, case series, case reports, and translational studies. Here, we performed a comprehensive systematic review and identified 170 studies describing ocular effects of ROCK inhibition. In addition to describing well-established ocular effects associated with inhibition of ROCK signalling, such asconjunctival hyperaemia, corneal verticillata, and reticular corneal epithelial oedema, we also highlight other effects, such as corneal haemorrhages, changes in corneal contour, anterior subcapsular opacities, contact dermatitis, punctal stenosis, and eyelid wound dehiscence, which have been described in case series and case reports. Finally, we evaluated studies describing potential novel applications of ROCK inhibition for treating disorders affecting the cornea, the retina, and the optic nerve, finding strong evidence in support of a beneficial effect of ROCK inhibitors on corneal oedema due to corneal endothelial cell dysfunction. The other potential applications require further research.

Three-snip punctoplasy with everting interrupted sutures versus three-snip punctoplasty with mini-Monoka stent for management of punctal stenosis (prospective comparative study)

Purpose To compare the results of three-snip punctoplasty with the placement of three everting interrupted sutures versus three-snip punctoplasty with mini-Monoka stent in managing punctual stenosis. Patients and methods Fifty adult patients underwent three-snip punctoplasty with three everting interrupted sutures in one eye (right eye) (group A), and the other eye (left eye) (group B) underwent three-snip punctopasty with mini-Monoka stent. The sutures and stent were removed 6 weeks after the surgery. Epiphora, punctal opening, tear height meniscus, fluorescein and disappearance test results were analyzed and compared to preoperative information. Results Hundred eyes of 50 patients with a median age of 59 years, and females accounted for 56% of the sample. Anatomical and functional success in the right eye (group A) was 87.8 and 85.7%, respectively. On the other hand, the left eye (group B) anatomical and functional success were 89.7 and 87.7%, respectively. Regarding epiphora, there was a statistically significant difference between presurgical and postsurgical follow-up examinations in both right and left groups regarding Munk score. Tear Meniscus Height (TMH) decreased all through the follow-up visits between the two groups, almost to half, with no significant difference between both groups. Conclusion Both three-snip punctoplasty with everting sutures and three-snip punctoplasty with mini-Monoka stent are successful techniques in the management of punctal stenosis.

Efficacy of topical 5-Fluorouracil in the management of ocular surface squamous neoplasia: a study of 101 eyes.

To study the efficacy and side-effect profile of topical 5-Fluorouracil (5-FU) in the treatment of ocular surface squamous neoplasia (OSSN). Retrospective study of 101 eyes of 100 patients treated with 5-FU with one week on and 3weeks off regimen. Of the 100 patients (101 eyes), the mean age at diagnosis of OSSN was 49 (median, 52years; range, 11-87years). History of prior intervention was noted in 6 (6%) eyes. Tumor epicenter included bulbar conjunctiva (n = 54; 53%), limbus (n = 27; 27%), and cornea (n = 20;20%). Mean number of cycles of topical 5-FU administered was 3 (median, 3; range, 1-8). Complete tumor regression was achieved with topical 5-FU in 89 (88%) eyes with a mean number of 2 cycles (median, 2; range, 1-6) of 5-FU. The remaining 12 (12%) lesions underwent additional treatment including excisional biopsy (n = 7), extended enucleation (n = 3), and topical Interferon alpha 2b (n = 2) for complete tumor control. Over a mean follow-up period of 6months (median, 5months; range, 1-36months) following treatment, tumor recurrence was noted in 2 (2%) patients, and side-effects were noted in 7 (7%) eyes including conjunctival hyperemia (n = 1), punctal stenosis (n = 1), sterile keratitis (n = 4), and limbal stem cell deficiency (n = 1). Topical 5-FU is an effective non-invasive therapy for OSSN with a minimal side-effect profile.

Pigtail with self-retaining bicanalicular intubation combined with Mitomycin C for the treatment of acquired lower punctal stenosis.

The pigtail was used to create an opening at the lower punctal site in grade 0 stenosis with insertion of self-retaining tube and Mitomycin C (MMC). The patients with acquired lower punctal stenosis (grade 0) were divided randomly into equal groups, Group A: were treated with pigtail and MMC 0.02% and Group B: were treated with pigtail alone. The pigtail was inserted through the upper punctum until its tip reached the occluded punctum, this site was incised with a scalpel (No. 11). A self-retaining bicanalicular tube was then placed. Results of 36 eyes from 26 patients were included. No differences were observed between both groups regarding epiphora score, FDD test and punctal size preoperatively. The postoperative epiphora score, there were significant differences at 1month (P = 0.035), 3months (P = 0.005), and 6months after removal (P < 0.001). The FDD test, there were significant differences at 6months (P = 0.045), 1month (P = 0.021), 3months (P = 0.012), and 6months post tube removal (P = 0.005). The punctal size, both groups differed at 1month (P = 0.045), 3months (P = 0.03), and 6months post tube removal (P = 0.005). Only one case (5.5%) at each group showed extrusion of the tube. The pigtail probe, bicanalicular stent and MMC can be an effective method in treatment of severe punctal stenosis.

Long-term Results of Punctoplasty With Canalicular Triangular Flap in Punctal Stenosis.

The aim was to describe the punctoplasty technique with canalicular triangular flap, and present the long-term results of the technique in patients with inferior punctal stenosis. The files of the patients who were diagnosed with punctal stenosis grade 0, 1, and 2 and underwent a canalicular triangular flap were evaluated retrospectively. The study was approved by the local ethical committee of the University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul. The demographic data, symptoms, prior interventions, punctal stenosis grading, associated eye pathologies, fluorescein clearance test, Munk score, and follow-up time were recorded. The puncta were evaluated biomicroscopically, and photographs were taken at each visit. The patients with at least 6 months of follow-up were included in the study. The loss of epiphora symptom, positive dye disappearance, and puncti ≥grade 3 opening were accepted as a success. A hundred and nine inferior puncti of 64 patients with symptoms of epiphora and punctal stenosis diagnosis were included in the study. Thirteen eyes were excluded as they were diagnosed to have punctal atresia or canalicular stenosis of a variable degree beyond punctum. The rest 96 eyes of 55 patients-65 eyes of 36 females and 31 eyes of 19 males-were included in the study as having pure punctal stenosis. The mean age of the patients was 64.3 ± 9.01 years (40-88 years). Forty-one patients had bilateral and 14 patients had unilateral punctal stenosis. Sixty-six were grade 1, and 30 were grade 2. Epiphora was the most commonly reported symptom.The mean follow-up time was 21.17 ± 10.5 months (6-46 months). In 76 (79.1%) eyes of 96, Munk score was 0 and in 15 (15.6%) eyes, Munk score was 1. Anatomical success as having puncta larger than grade 2 was recorded in 97.9%, and functional success was recorded in 94.6% of anatomically successful eyes. No restenosis was recorded in any punctum. Although the techniques of 1-snip, 2-snip, 3-snip, and 4-snip punctoplasty are performed with variable success rates in punctal stenosis patients, there is always a risk of restenosis due to the incision of the flap and unpredictability of the way the tissues will epithelize. In the canalicular triangular flap technique, the canalicular mucosal flap is preserved, and the continuity of the lacrimal mucosa with conjunctiva is provided, which utilizes appropriate re-epithelization of the wound edges, resulting in a wide punctal opening for the upper lacrimal system in the long term.

Association Between Acquired Punctal Stenosis and Ocular Surface Disease: the Egg and the Chicken Story

ABSTRACT Purpose This study explores the relationship between acquired punctal stenosis (PS) and ocular surface disease (OSD), assessing causal mechanisms and clinical impacts, utilizing a combination of a comprehensive literature review and a detailed analysis of a patient cohort from a tertiary care center. Methods Data from 213 PS patients at Sheba Medical Center were retrospectively analyzed, evaluating various OSD symptoms and treatment effectiveness through standardized clinical assessments and statistical tests. Results Predominantly older and female, many patients exhibited bilateral PS. OSD symptoms were found in 35.2% of all patients. Treatments like punctoplasty with stents significantly alleviated symptoms. Significant associations between treatment modalities and symptom improvement were identified. Conclusions PS and OSD have acomplex, bidirectional relationship that complicates treatment outcomes. This study underscores the need for thorough diagnostic approaches and personalized treatments to improve PS management. Further research is essential to deepen understanding of PS-OSD interactions and develop effective therapies.

Punctal and Canalicular Stenosis Following Topical 1% 5-Fluorouracil Eye Drop Therapy for Ocular Surface Squamous Neoplasia.

To present the first known cases of punctal and canalicular stenosis following topical 5-fluorouracil (5-FU) eye drops for ocular surface squamous neoplasia (OSSN). A retrospective chart review of patients with OSSN receiving topical 1% 5-FU eye drops as a primary or adjuvant treatment between 2013 and 2021 was performed. Individuals diagnosed with punctal or canalicular stenosis during or after topical 5-FU use were included in this study. Four individuals met these criteria; we report clinical findings and treatment course for each patient. We reviewed 303 patients (316 eyes) with OSSN. All patients were treated with topical 1% 5-FU eye drops in cycles, given 4 times daily for 1 week with 3 weeks off. Four patients (5 eyes) developed punctal stenosis, for a frequency of 1.3%. The mean age at 5-FU initiation in the 4 individuals was 61 years (range 53-69). Most individuals were male (75%), White (75%), and non-Hispanic (100%). The most common presenting symptom of stenosis was epiphora, noted 4.6 ± 3 months after initiating topical 5-FU (after 4.9 ± 2.0 cycles). This occurred in 4 eyes while on therapy (3, 2, 4, and 4 months since 5-FU initiation) and in 1 eye after stopping therapy (10.3 months since 5-FU initiation). In 1 eye, punctal stenosis and epiphora resolved spontaneously after stopping 5-FU. Punctal dilation led to symptom resolution in 2 eyes. Surgical intervention (punctoplasty and external dacryocystorhinostomy) was needed in 2 eyes for punctal and canalicular stenosis, respectively. Punctal or canalicular stenosis is a rare and previously unreported adverse effect of topical 5-FU that may require surgical treatment.

The Use of Venous Catheter and Irrigation with Povidone-Iodine 0.6% in Patients with Punctal and Proximal Canalicular Stenosis: Preliminary Report.

Background: This study aimed to evaluate the safety and efficacy of povidone-iodine 0.6% (PVI) irrigation for preventing recurrence of stenosis after punctoplasty in patients with punctal and proximal canalicular stenosis treated using a venous catheter as a stent. Methods: Twenty patients were enrolled and divided into two groups. Group 1 received irrigation of 1 mL 0.6% PVI, while Group 2 received 1 mL of balanced salt solution (BSS). The patients underwent baseline, 15-, 30-, and 90-day assessments using the Ocular Surface Disease Index (OSDI) questionnaire, Symptoms Assessment in Dry Eye (SANDE), Schirmer I test, tear meniscus height (TMH), bulbar redness, meibography, and non-invasive breakup time (NIKBUT) through Keratograph 5M (Oculus, Germany). Results: At three months, both groups demonstrated statistically significant improvements in symptoms and ocular surface parameters. However, Group 1 showed statistically significant improvements in OSDI, SANDE scores, bulbar redness, and NIKBUT compared to Group 2. Additionally, no patients in Group 1 presented a recurrence of stenosis, while three patients in Group 2 demonstrated stenosis relapse at the end of the follow-up period. Conclusions: The application of a venous catheter and PVI 0.6% irrigations proved to be effective in treating proximal lacrimal duct stenosis, reducing the risk of recurrence and improving tear film stability, ocular discomfort symptoms, and ocular surface parameters.

Dyskeratosis congenita: beyond the triad and beyond the cause

Introduction: Dyskeratosis congenita (DC) is a rare genodermatosis caused by mutations in various genes encoding the proteins responsible for maintaining the telomere length. It is defined by the presence of three clinical features: nail dystrophy, abnormal skin pigmentation, and oral leukoplakia. We herein report a typical case of DC with all three classical features along with pancytopenia, osteopenia, and epiphora but with no identifiable pathogenic mutations of DC-associated genes. Case presentation: Cutaneous examination revealed areas of hypopigmented and hyperpigmented macules forming a reticular pattern all over the body but mainly over the neck and upper chest, with relative sparing of the face. Skin atrophy with hypopigmentation was observed on the knuckles. The nails showed dystrophy in the form of pterygium, anonychia, and brittleness. The palms showed mild wrinkling with hypopigmented macules. Examination of the oral cavity revealed a white non-removable coating over the tongue and bilateral buccal mucosae (oral leukoplakia); the teeth were normal. Syringing of both eyes was performed by an ophthalmologist, and the patient was diagnosed with punctual stenosis (occlusion of the opening of the lacrimal canaliculus). Discussion: DC is a genodermatosis caused by germline mutations in genes encoding telomerase-associated components, shelterin proteins, and other regulators of telomere length and replication. Depending upon the gene involved, the mode of inheritance can be X-linked autosomal dominant or autosomal recessive. DC is characterized by the clinical triad of abnormal skin pigmentation, dystrophic nails, and oral leukoplakia. Patients with DC are also known to develop other rare clinical features at later stages, including epiphora, early graying of the hair, premature tooth loss, enteropathy with malabsorption, immune deficiency, esophageal stricture, cardiomyopathy, liver cirrhosis, osteoporosis and avascular necrosis of the bone. Patients with DC are predisposed to the development of malignancies, especially hematological malignancies and head/neck cancer. Management of DC involves a multidisciplinary approach and includes genetic counseling of family members at risk, regular surveillance of the patient for bone marrow failure and malignancies, and treatment of the associated features and any complications. Conclusion: Dyskeratosis congenita (DC) is a rare genodermatosis caused by mutations in various genes encoding telomerase complex. We present a typical case of DC with all three classical features but with no pathogenic mutations of existing DC-associated genes thus raising the possibility of new unidentified genes in the pathogenesis of DC.

Prevalence of punctal stenosis as a cause of obstructive epiphora

Purpose The aim of this study was to evaluate the prevalence of punctal stenosis in the patients presenting with eye watering due to obstructive epiphora. Patients and methods This descriptive, cross-sectional, prospective study included 75 eyes of 51 patients. The enrolled patients were classified into two groups; group 1 that included patients with punctal stenosis and group 2 that enrolled patients with obstructive epiphora due to other causes. Age subgrouping was performed to determine the prevalence of punctal stenosis among various age groups. Results The mean age of the patients was 52.32±16.19 years. Punctal stenosis was the most encountered cause of obstructive epiphora (32 patients=62.75%) in the study population. Punctal stenosis was also the most prevalent cause of obstructive epiphora (56.3%) in the oldest age subgroup (&gt;60 years). Conclusion Punctal stenosis is the most common cause of obstructive epiphora in patients presenting with eye watering. Increasing age is the most important determinant of punctal stenosis.

An anterior segment optical coherence tomography study of lower lacrimal punctal stenosis

Aims To assess the lower lacrimal punctal measurements in patients with punctal stenosis versus normal participants using anterior segment optical coherence tomography (AS-OCT). Patients and methods The study included 39 puncti of 21 healthy asymptomatic volunteers attending the general and oculoplastic outpatient clinics (group I: control group) and 30 puncti of 17 patients with a clinical diagnosis of punctal stenosis defined as the punctal diameter less than 0.3 mm measured by slit-lamp biomicroscopy (group II: cases group). The punctal diameter is measured by slit-lamp biomicroscopy in all participants. The external punctal diameter, the inner punctal diameter at three depths (100, 200, and 500 μm), the punctal depth and tear meniscus height were measured using AS-OCT. Results The internal punctal diameter at 100 μm (239.51±91.14 vs. 168.77±118.07 µm), 200 μm (156.67±75.20 vs. 71.63±76.41 µm), and 500 μm (74.92±60.99 vs. 24.07±34.30 µm) showed statistically significant lower measurements in the cases group compared with the control group. No statistically significant differences were found comparing both groups regarding external punctal diameter otherwise. In the cases group, the punctal diameter measured by slit-lamp biomicroscopy had highly significant statistical evidence of positive correlation with the internal punctal diameter at 200 μm. Conclusion AS-OCT provides a superior ability to assess the patency of the proximal lacrimal drainage system over the routine slit-lamp examination, especially when the internal punctal diameter is measured at a depth of 200 µm. Further research is required to build consensus on standard terminologies, define the standard measurements, and acquire more extensive normative databases. This would mostly be useful in diagnosis of cases of epiphora with externally nonstenosed puncti and distally patent passages.

Canalicular obstruction associated with dupilumab.

Dupilumab is a novel treatment for severe atopic dermatitis and is associated with a range of ocular complications such as blepharoconjunctivitis, keratitis, cicatricial ectropion and punctal stenosis. We report 4 patients with canalicular obstruction in association with dupilumab therapy, and we describe their treatment and outcomes in each case. Canalicular obstruction was diagnosed by an oculoplastic consultant between 3years and 3months and 4years and 9months after the commencement of dupilumab therapy. Case 1 underwent nasolacrimal intubation, case 2 was treated conservatively, and case 4 underwent endonasal dacryocystorhinostomy and these patients' symptoms resolved. Unfortunately, in case 3 despite endonasal dacryocystorhinostomy with stenting they remained symptomatic. This case series adds to the growing number of ocular complications associated with dupilumab therapy, and there is yet an optimal treatment strategy to mitigate these complications. It is possible that simple conservative measures such as discontinuation of dupilumab and topical treatments with steroids can eventually lead to some form of recovery and recanalisation of the canalicular system. Early referral to an ophthalmologist prior to the development of canalicular obstruction to control the inflammatory ocular surface could reduce the risks of cicatricial sequelae from dupilumab, and temporary stenting of the canalicular system could be attempted as a method to keep the canalicular system patent, whilst the patient remained on treatment.

The Prevalence of Punctal Stenosis as a Cause of Obstructive Epiphora in Ain Shams University Hospitals Ophthalmology Clinic

Background Epiphora or tearing is the presence of a watering eye, which is a common complaint to be referred to oculoplastic clinics for evaluation. Not only does it cause social embarrassment, epiphora can also affect the quality of a patient's life as it may interfere with daily activities, especially reading and driving. Excessive tearing may also hinder proper visual performance. Aim of the Work To calculate the prevalence of punctal stenosis in patients presenting with obstructive epiphora to the outpatient ophthalmology clinic at Ain Shams University Hospitals. Patients and Methods This descriptive cross sectional study included 75 eyes of 51 patients, with the age ranging from 4.5 to 77 years and a mean age of 52.32 ± 16.19 years. The study results showed that punctal stenosis is the most commonly encountered cause of obstructive epiphora in the study population with a prevalence of 62.7%. There was a female predominance of epiphora and punctal stenosis (68%). Results Our study results revealed that epiphora was more prevalent in the older age subgroups, where the highest prevalence was among the oldest age subgroup (&amp;gt; 60 years old) (45.1%). Similarly, punctal stenosis was the most prevalent in the &amp;gt; 60 years old age sub group (56.3%). Conclusion Punctal stenosis is the most commonly encountred cause of obstructive epiphora in the study population, with a female predominance. Moreover, increasing age was shown to be the most important determinant for the existence of punctal stenosis.

Topical cyclosporin A 0.05% eye drops for management of symptomatic acquired punctal stenosis: a prospective, controlled clinical study

ABSTRACT Purpose To study the efficacy of cyclosporin 0.05% eye drops in the management of grade 1 and 2 acquired punctal stenosis and to compare the results with the clinical outcomes of mini-Monoka insertion. Methods A prospective, controlled, interventional clinical study includes all patients (16 years and older) with symptomatic epiphora and diagnosed with grade 1 or grade 2 acquired punctal stenosis. All patients undergo punctal dilatation, canalicular probing, and nasolacrimal duct irrigation. Afterwards, patients are divided into two groups: Group A: patients receive only medical treatment in the form of topical 0.05% cyclosporin (Restasis®, Allergan Inc.) twice daily for 6 months. Group B: patients receive mini-Monoka stent insertion in the lower canaliculus for 6 weeks. Outcome measures are changes in Munk scoring, grading of the punctum, and functional and anatomical success. Functional success is defined as Munk score 0 to 1 and FDDT grade 0–2. Anatomical success is defined as grade 3 punctum. Results Forty-two patients are included in the study, with 21 patients in each group. There were no significant differences in the Munk score between the two groups before treatment; however, group B had a significantly higher mean rank at 6 months after treatment. After treatment, the punctal size was significantly larger in group B at 4 weeks and 3 months. However, no significant difference in punctal size was detected at 6 months after treatment between the two groups. Conclusion Application of cyclosporin 0.05% eye drops is a simple and efficient non-interventional method in the management of grade 1 and 2 acquired punctal stenosis.

Effectiveness of an Auto-stable Bicanaliculus Intubation Stent in the Management of Acquired Punctal Stenosis

Objective: To determine the effectiveness of an autostable bicanaliculus Intubation stent in the management of acquired punctal stenosis in adults.Study Design: Quasi-experimental study.Place and Duration of Study: The study was carried at the Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan, from April 2022 to November 2022.Materials and Methods: This Quasi-experimental study is being conducted from April 2022 to November 2022 after approval from the hospital ethical review committee. A sum of 16 subjects were included in this study, of which 11 were females, and 4 were males, while one patient did not fulfill the follow-up criteria of our study, so was not included. In adult patients with proximal punctual stenosis, bicanalicular auto-stable self-retaining stents were implanted after performing probing sac syringing. Follow-up was done up to 06 months, and anatomical and functional success was determined with the help of munk score system of epiphora, which states 0 means no epiphora and 5 means constant epiphora.Results: Out of 15 subjects, 11 (73.3%) were females, and 4 (26.7%)) were males, who underwent bicanalicular stents. In 14 (93.3%) subjects, anatomical and functional success was noticed, while in one (6.7%) patient, extrusion of the tube occurred.Conclusion: The treatment of proximal punctual stenosis in adults can be easily done with the help of bicanalicular auto-stable self-retaining stents which not only improve the anatomical success rate but also improves the functioning of the puncti.

Evaluation of Distal Occlusions accompanying Punctal Stenosis using Radionuclide Imaging in patients with Unilateral Epiphora

Objective: Our objective was to evaluate distal occlusions accompanying punctal stenosis, which can lead to impaired nasolacrimal drainage in patients with punctal stenosis, using radionuclide imaging. Material and Methods: Our study enrolled 42 patients who had unilateral punctal stenosis and experienced epiphora on the same side. None of the patients had previously undergone surgical intervention for this condition. Ophthalmological examination results were normal on the unaffected side. Dacryoscintigraphy was performed bilaterally, and specific regions of interest were identified. The scintigraphic images were assessed quantitatively and qualitatively by two nuclear medicine specialists. Evaluation between the nuclear medicine specialists was conducted using the McNemar Bowker test and the Kappa test. Results: Eighty-one percent (34) of the patients were female. The mean age of the patients was 68.23±9.67 years. In patients with punctal stenosis, the punctal area exhibited edematous features. The lacrimal drainage pathway from the punctum was assessed by two nuclear medicine specialists using two different methods. In the visual quantitative evaluation to determine the localization of the stenosis, there was a low to moderate agreement between the two observers (p=0.018, kappa value=0.252). In the quantitative evaluation, there was excellent agreement between the observers (p=0.0001, kappa value=1). Conclusion: Dacryoscintigraphy is preferred as an imaging method due to its non-invasive nature that does not disturb the physiological processes. It offers advantages such as lower radiation exposure and higher patient compliance compared to dacryocystography. However, it should be noted that the anatomical correlation in dacryoscintigraphy is relatively low compared to radiological methods. By incorporating quantitative data into the visual assessment of dacryoscintigraphy, it may be possible to enhance anatomical correlation and improve observer agreement, particularly in patients presenting with a combination of functional and anatomical obstructions.

Perforated Punctal Plugs for the Management of Acquired External Punctal Stenosis

The study presents the results of treating patients with pathological tearing caused by acquired external punctal stenosis.&#x0D; Method: 61 eyes of 34 individuals with an average age of 67 were enrolled in the study. A perforated silicone implants were inserted into the narrowed lacrimal punctums, after pathological tearing had been diagnosed using the Munk test, fluorescein disappearance test, and other parameters. Implants has been removed after 3 months.&#x0D; Results: Overall, a statistically significant (p &lt; 0.001%) reduction in the fluorescein disappearance test was observed in 93.2% of eyes (n = 55). None of the patients experienced an exacerbation of excessive tearing. The average score on the fluorescein disappearance test decreased from 3.64 before the procedure to 1.42 after the procedure.&#x0D; Conclusions: Intubation of the lacrimal punctum with perforated silicone implants is a quick, effective, and safe method for treating pathological tearing in cases of acquired narrowing of the lacrimal punctum.

Clinical features and management of keratoconjunctivitis associated with inadequate tear drainage

ObjectifDécrire les caractéristiques cliniques et la prise en charge de la kératoconjonctivite toxique associée à une sténose du point lacrymal et/ou du canalicule (« effet cocktail » ou toxic soup syndrome). NatureÉtude d'observation rétrospective portant sur une série de cas. MéthodesOn a procédé à une recherche du mot-clé « effet cocktail » (toxic soup syndrome) et réalisé un examen rétrospectif des dossiers médicaux électroniques. Ainsi, 35 yeux de 25 patients avaient été examinés dans une clinique de soins tertiaires spécialisée dans les troubles de la cornée entre janvier 2017 et décembre 2021. On a noté le sexe, l’âge, l'acuité visuelle corrigée de loin, l'utilisation de collyres, les symptômes, les signes cliniques et les résultats des interventions médicales et chirurgicales. Le principal paramètre de mesure portait sur l'amélioration des signes et des symptômes de la surface oculaire après les interventions. RésultatsDans l'ensemble, 35 yeux de 25 patients (âge moyen : 66,8 ± 12,8 ans; 72 % de femmes) ont été inclus dans notre étude. Les principaux symptômes de tous les patients étaient l'hyperémie et l’épiphora. De même, tous les patients avaient une rosacée oculaire ou une maladie des glandes meibomiennes, 7 patients (28 %) présentaient un glaucome, et une insuffisance en cellules souches limbiques est apparue chez 7 patients (28 %). Lors de la visite initiale, 22 patients (88 %) utilisaient des collyres. On a noté la présence d'un bouchon méatique, d'une cautérisation du point lacrymal ou d'une sténose du point lacrymal et/ou du canalicule dans tous les yeux. La prise en charge a consisté en l'interruption de l'administration de tous les collyres contenant un conservateur et la mise en place d'un traitement anti-inflammatoire quelconque. Ainsi, 19 patients (76 %) ont bénéficié d'une amélioration du drainage lacrymal. Un seul patient qui présentait une obstruction importante du canalicule a dû faire l'objet d'un traitement au long cours reposant sur des stéroïdes topiques sans conservateur. ConclusionsLa présence d'une sténose du point lacrymal et/ou du canalicule peut aggraver la conjonctivite toxique secondaire aux effets des collyres administrés à long terme ou de l'ensemble des médiateurs inflammatoires, ce qui donne lieu à un effet cocktail. La disparition de l'obstruction du point lacrymal s'est traduite par une amélioration de l’état de la plupart des patients.