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The puncti are positioned medially, near the medial canthus. They are located within the papillae. This complex opens into the tear layer. The tears are collected through the puncti and into the canaliculi.

The puncti are positioned medially, near the medial canthus. They are located within the papillae. This complex opens into the tear layer. The tears are collected through the puncti and into the canaliculi.

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Acquired punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded. This condition is a rare cause of symptomatic epiphora, but its incidence may be higher in patients with chronic blepharitis, in those treated with various topical medications, including antihypertensive agents, and especially...

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... lacrimal puncti are positioned at the medial part of the eyelid margins ( Figure 1). They open into the tear lake near the plica semilunaris and the bulbar conjunctiva. ...

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... Lacrimal punctal stenosis is one of the least-evaluated etiologies of epiphora [1]. It is defined as narrowing or occlusion of the external opening of the lacrimal canaliculi, while the distal tear drainage system is free [2,3]. It can also be defined more precisely as the punctum size less than 0.3 mm or inability to cannulate it with a 26G cannula without dilation [4]. ...
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Purpose: To evaluate the role of medical treatment and assessing its effect on resolving epiphora and improving punctum size by high resolution AS-OCT imaging comparing punctal parameters in patients before and after treatment with topical combined antibiotic and steroid treatment in cases of inflammatory punctual stenosis. Patients and Methods. Double-blinded controlled randomized study which was conducted on two groups of patients who had acquired punctal stenosis and epiphora presented to Ophthalmology Clinics of Sohag University Hospitals in the period between Jan 2021 and April 2021. The study included 44 eyes of 50 subjects complaining of epiphora. They were divided into two groups, the epiphora group one (EG1) received eye drops containing combination of antibiotics and steroids (orchadexoline eye drops, each ml contains 5 mg chloramphenicol, 1 mg dexamethasone sodium phosphate, 0.25 mg tetryzoline hydrochloride, 2 mg hydroxypropyl methyl cellulose, 10 mg α-tocopherol acetate (vitamin E), and 8 mg macrogol 400), 5 times daily for the first week, three times daily for the next two weeks, and one time daily for another one week. The second epiphora group (EG2) received preservative-free artificial tears (sodium hyaluronate-, polyethylene-, and propylene glycol-based), three times daily for four weeks. The patients were examined before treatment, one week, one month, and one and half months later. Results: Both groups were comparable regarding mean age (49 ± 13 vs 53 ± 11 years, P value = 0.2) and sex (males were 38.6% vs 31.8%, female were 61.4% vs 68.2%, P value = 0.6), respectively, with no statistically significant difference between both groups. Both groups were comparable regarding outer punctual diameter and length between the puncti before treatment. Outer punctal diameters were (EG1 228 ± 113 um, EG2 241 ± 115 um, P value = 0.5). Length between the puncti were (EG1 129 ± 73 um, EG2 137 ± 72 um, P value = 0.6). There was marked improvement of the outer punctual diameter (EG1 373 um ± 92 um, EG2 240 ± 109 um, (P value < 0.0001) and length between the puncti (EG1 217 ± 109 um, 136 ± 71 um (P value < 0.0002)) during the follow-up period. EG1 showed more improvement than EG2 when compared during the follow-up period. Conclusions: Topical combined antibiotic and steroid treatment was an effective method in treating cases of inflammatory punctual stenosis as found by monitoring of punctal parameter changes by AS-OCT. AS-OCT was found to be a useful method for evaluation of the lacrimal punctal parameters especially with different treatment modalities in epiphora cases.
... most efficacious way to perform the procedure (1,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). ...
... Punctoplasty was introduced in 1853 by Bowman (6) and in 1962 by Jones (7) re-popularized one-snip punctoplasty, and he suggested periodic punctal dilatation to prevent wound re-approximation and fibrosis-related failure if the punctum is showing to re-stenosis findings. Despite this historical information in the literature (1,(6)(7)(8), there is a lack of large-scale study involving the results of one-snip punctoplasty with adjunctive punctal dilatation for early post-operative cicatricial changes. The one-snip punctoplasty, which a single vertical snip down the ampulla, has been reported to have a failure because of recurrence secondary to wound re-approximation (6)(7)(8)(9)(10)(11)18). Jones (7) suggested that if the punctum tenting to re-stenosis after one snip punctoplasty procedure, successful results can be achieved with periodic punctal dilation. ...
... Due to the advantages and disadvantages of all these methods described, it is difficult to establish a standard procedure for the treatment of AEPS (6-11, 18, 19) Among various snip procedures described, the three-snip punctoplasty is the most popular and has been documented with high success rates (8-10, 18, 19). However, it is believed to cause damage to both vertical and horizontal canaliculus, and consequently lacrimal pump function (1,8,9). The anatomic success varied from 31 to 94%, and the functional success varies from 18 to 81% between studies (8)(9)(10)19). ...
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Objectives: This was an assessment of one-snip punctoplasty outcomes in patients for whom adjunctive punctal re-dilatation was performed in-office for early postoperative cicatricial changes. Methods: A retrospective analysis was conducted of patients who underwent one-snip punctoplasty between March 2019 and February 2020 due to acquired punctal stenosis. Patients were followed up on the first, third, and seventh postoperative day, then weekly for the remainder of the first month, every 2 weeks over the next month, and then monthly. Punctal re-dilatation was performed if patients showed early clinical signs of re-stenosis. Demographic details, the number and timing of re-dilatation procedures, the timing of re-stenosis, and anatomical and functional success rates were analyzed. Results: The medical records of 148 eyes of 86 patients were evaluated. A re-dilation procedure was performed in a total of 57 (38.5%) puncta showing signs of early cicatrization. The first punctal re-dilatation was performed at a mean of 17.2±11.3 days (range: 3-57 days). Re-stenosis was observed in 25 puncta (16.9%) at a mean of 5.6±3.1 weeks (range: 2-16 weeks). The anatomical success rate was 83.1% and the functional success rate was 79.1%. There were no significant differences in the anatomical and functional success rates between the patients who did and did not need adjunctive re-dilatation. Conclusion: In-office punctal re-dilatation may improve functional and anatomical success rates after one-snip punctoplasty by preventing recurrent punctal cicatrization.
... Acquired or congenital abnormalities in the size and morphology of the lacrimal punctum and canaliculus may contribute to excess tears. The incidence of punctal stenosis is still unknown, with reported rates ranging from 8% to 54.3%, depending on the setting, demographics, and possibly interobserver variability [1]. Most of the previous parameters of the lacrimal punctum and canaliculus were obtained from autopsies, without anatomical parameters in vivo. ...
... Most of the previous parameters of the lacrimal punctum and canaliculus were obtained from autopsies, without anatomical parameters in vivo. Slit-lamp microscopy is usually used to check the lacrimal punctum in clinical practice [1]. Although easy to perform, this technique is highly subjective Ivyspring International Publisher and lacks a unified standard for judging the size of the lacrimal punctum. ...
... Although easy to perform, this technique is highly subjective Ivyspring International Publisher and lacks a unified standard for judging the size of the lacrimal punctum. In addition, it is difficult to observe the internal situation of the lacrimal punctum [1]. Hurwitz et al. showed that ultrasound biomicroscopy (UBM) could be used to exam the lacrimal canaliculus [2]. ...
Article
Purpose: The anatomical parameters of normal lacrimal puncta and vertical canaliculus using optical coherence tomography (OCT) and the OCT imaging features of punctal lesions were analyzed to provide a basis for clinical diagnosis and treatment. Methods: From June to September 2019, 40 volunteers (80 eyes) from Tongji Hospital were enrolled. The external punctal diameter (ELP) was measured using slit-lamp microscopy and OCT. The internal lacrimal punctal diameter (ILP) at 100 μm, vertical canalicular length (VCL), and tear meniscus depth were measured by OCT with open eyes. Twenty-eight volunteers (56 eyes) underwent the same examinations with their eyes closed. The OCT imaging features of 26 patients (27 eyes) with lacrimal lesions were examined. Results: The ELP of the right and left healthy eyes under slit-lamp microscopy were 564.40 and 555.40 µm respectively. Under OCT, the ELP, ILP, and VCL of the right and left eyes were 628.20 um and 616.85 µm, 343.40 µm and 346.95 µm, 731.95 um and 709.20 µm respectively. The ELP was larger when measured by OCT than slit-lamp microscopy (p<0.05). Twenty-eight volunteers (56 eyes) had measurements taken under different conditions. The ELP, ILP, and VCL of the open and closed right eyes were 667.54 and 567.21 µm, 369.18 and 303.18 µm, 715.00 and 417.14 µm, respectively. The ELP, ILP, and VCL of the open and closed left eyes were 655.86 um and 551.68 µm, 369.25 um and 313.54 µm, 719.96 um and 433.89 µm respectively. The anatomical parameters of the open eyes were greater than those of the closed eyes (p<0.05). Thus, we identified the imaging features of lacrimal stenosis, punctal obstruction, punctal tear, lacrimal atresia, and lacrimal mass using OCT. Conclusions: OCT can be used to measure the anatomical parameters of lacrimal puncta and vertical canaliculus in vivo. In addition, OCT can detect punctal lesions in vivo and provide an objective basis for the clinical diagnosis and treatment of punctal lesions.
... In many cases, no cause is identified and the condition is referred as idiopathic. [1][2][3][4][5][6][7][8] Management of punctal stenosis should restore adequate punctal opening with preservation of the lacrimal pump. It has been conventionally managed by procedures known as snip punctoplasty (one, two, or three snips). ...
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Purpose: Assessment of the efficacy of upper and lower one-snip punctoplasty combined with silicone tube stenting for the management of bi-punctal stenosis. Methods: Prospective interventional case series of 20 patients (33 eyes, 66 puncta) with epiphora due to bi-punctal stenosis. All the patients were subjected to bi-punctal 1-snip punctoplasty with silicone intubation, and the tube was kept for 3 months. The follow-up was extended for 6 months after tube removal. The resolution of epiphora with patent puncta was considered as a complete functional success, while patent puncta with residual epiphora were considered as an anatomical success. Results: The mean patients’ age was 41.3 years and 55% were females. Grade 0 puncta were found in 9.1%, and grade 1 represented 39.4%, while 51.5% had grade 2 puncta. Silicone tube was removed after an average period of 12.1 ± 2.7 weeks. Complete functional success was reported in 90.9% while anatomical success was noticed in 97%. Conclusion: One-snip punctoplasty combined with 3 months of silicone intubation can be considered in the management of bi-punctal stenosis achieving high success rates with a minor discrepancy between functional and anatomical outcomes.
... Nasal endoscopy should be performed to detect intranasal tumours or polyps, turbinate impaction, deviated septum, or chronic allergic rhinitis, that must be excluded before surgery (Soiberman et al. 2012). ...
... Infections by chlamydia, herpes simplex, actinomyces and human papilloma virus may also cause punctal stenosis (Tabbara & Bobb 1980;Jager & Van Bijsterveld 1997). Systemic and topical medications have also been associated and include 5-fluorouracil, docetaxel and paclitaxel Soiberman et al. 2012;Mansur et al. 2017); topical agents like prednisolone acetate, dexamethasone, phenylephrine hydrochloride, adrenaline, antibiotics (chloramphenicol and tobramycin), indomethacin, tropicamide, naphazoline and artificial tears (McNab 1998;Kashkouli et al. 2003). Antiglaucoma agents (beta-blockers, pilocarpine, dorzolamide, prostaglandin analogues) are responsible of peculiar histological findings, including conjunctival metaplasia, decrease of goblet cells and increase of sub-conjunctival fibroblasts, macrophages and other inflammatory components (Kristan & Branch 1988;Herreras et al. 1992;Schwab et al. 1992;Pisella et al. 2002). ...
Article
Purpose The aims of the review are to summarize the aethiopathogenesis, management and outcomes of different treatments of proximal lacrimal obstructions. Methods An electronic database (PubMed, MEDLINE and Google Scholar) search of all articles written in English and non‐English language with abstract translated to English on proximal lacrimal obstructions was performed. The articles were reviewed along with their relevant cross references. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. Results Punctoplasty is as effective as punctal dilatation with monocanalicular or bicanalicular stent in case of punctal stenosis. Dacryocystorhinostomy with retrograde intubation is more effective in case of proximal canalicular obstructions than in case of mid‐canalicular obstructions. Trephination and intubation is effective in both mid and distal canalicular obstructions in patients with no associated nasolacrimal duct obstruction. Canaliculodacryocystorhinostomy has a specific indication in case of proximal common canalicular obstruction. Bypass surgery is the preferred treatment if there is no residual patency, however surgical success may not match patient satisfaction. Conclusion Optimal choice of surgical method depends on identification of the site of obstruction. Mini‐invasive techniques should be avoided in cases that would only benefit from standard surgical treatment.
... The association between punctal stenosis and Dupilumab therapy is rarely reported [5] [11]. The pathogenesis of punctal stenosis may involve chronic inflammation from conjunctivitis leading to cicatrix and gradual fibrotic change of external puncta with eventual stenosis [12]. ...
... Original Article with a surrounding fibrous ring [2]. Punctal stenosis can be congenital or acquired, with a broad spectrum of etiologies that include trauma; dry eye disease; inflammatory diseases, such as blepharitis; lid margin malposition, mainly ectropion; and age-related changes. ...
... Punctal stenosis can be congenital or acquired, with a broad spectrum of etiologies that include trauma; dry eye disease; inflammatory diseases, such as blepharitis; lid margin malposition, mainly ectropion; and age-related changes. It can also develop secondary to radiotherapy or use of topical eye drops, such as antiglaucoma medications [2,3]. Diagnostic procedures include slit-lamp examination to assess the size and location of the punctum, and examination of the lid margin and conjunctiva for chronic diseases, such as blepharitis or lid margin malposition. ...
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Background: To compare the short-term anatomical and functional outcomes of, as well as patient satisfaction with, lacrimal stenting and three-snip punctoplasty for the treatment of punctal stenosis or occlusion. Methods: In this open-label, randomized clinical trial, we included 50 eyes of 30 patients diagnosed with punctal stenosis or occlusion. They were randomly allocated to two groups of 25 eyes each, using central telephone randomization. Group A underwent a lacrimal stenting procedure and was subdivided into two subgroups: Group A1 (13 eyes) received polyvinylpyrrolidone-coated perforated punctal plugs, and Group A2 (12 eyes) received closed intubation using a bicanalicular silicon tube. Group B included 25 eyes that underwent three-snip punctoplasty. All eyes were examined after 1 day, 1 week, 1 month, 3 months, and 6 months. Postoperative anatomical success assessing the punctum size, functional success using the fluorescein disappearance test, and patient satisfaction based on epiphora scoring were recorded. Results: Both study groups were comparable in terms of sex and age distribution. Compared to Group B, Group A had a significantly larger punctum size at one, three, and 6-month postoperatively (P = 0.009, 0.01, and 0.02, respectively). The difference in FDT results was significant between the two groups at all follow-up visits (P = 0.008, 0.0001, 0.003, and 0.002, at postoperative one week, one-months, three-month, and six-month, respectively). Likewise, patient satisfaction was significantly different between both groups at all follow-up visits (P = 0.007, 0.001, 0.005, and 0.002, at postoperative one week, one-months, three-month, and six-month, respectively). Conclusions: Lacrimal stenting is an effective method for the treatment of punctal stenosis or occlusion. Overall, the FDT results and patient satisfaction outcomes were significantly better.
... En ocasiones la estenosis del punto impide el paso de la sonda y se hace necesario realizar una puntoplastia. (5) Las técnicas quirúrgicas para el abordaje del punto lagrimal están descritas por Bowman desde el año 1853, quien le realizaba un corte al punto fimótico. Con el paso de los años aparecieron variantes de puntoplastia de 2 y 3 cortes, así como la combinación con suturas y el uso de antimetabolitos, como la mitomicina C. Muchos autores prefieren la colocación de un tutor de Revista Cubana de Oftalmología. ...
Article
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RESUMEN Objetivo: Determinar los resultados alcanzados con la utilización de la puntoplastia en dos cortes modificada en el manejo de los pacientes con estenosis de los puntos y canalículos lagrimales inferiores. Métodos: Se realizó un estudio descriptivo y retrospectivo de una serie de casos, en el Hospital Universitario Clínico Quirúrgico "Comandante Manuel Fajardo", desde enero del año 2016 a diciembre de 2018. La muestra quedó conformada por 22 pacientes (38 ojos), sometidos a la técnica quirúrgica, y fue caracterizada de acuerdo con la edad, el sexo, el color de la piel, la bilateralidad, la localización anatómica de la obstrucción, los antecedentes patológicos personales, las complicaciones y la evaluación funcional final. Resultados: De un total de 22 pacientes, 17 estuvieron entre las edades de 60 y 79 años, el 72,7 % del sexo femenino y el 86,4 % con piel de color blanco. La blefaritis fue el principal antecedente oftalmológico encontrado (18,2 %), la obstrucción fue bilateral en el 72,7 % de los casos, y fundamentalmente a nivel del punto lagrimal (16 casos). El 86,8 % no mostró complicaciones posoperatorias; 3 casos presentaron extrusión del tutor de silicona, los cuales estuvieron en relación con el fallo en el resultado final. En el 92,1 % se constató el éxito de la cirugía.
... In our study we treated patients with grade 2 inflammatory punctual stenosis [4] with either a combination of preservative free steroids and artificial tears or artificial tears only. We found the same risk factors mentioned in previous studies as old age and female gender [4,13] , where the mean age of patient's in our study was 56.8±6.8y and 68% of them were females. We used spectral domain anterior segment-OCT images for visualizing the lacrimal punctual structure in vivo and differentiating various causes of epiphora [14] . ...
Article
Full-text available
Aim: To evaluate the role of medical treatment in the management of inflammatory punctum stenosis guided by spectral domain anterior segment optical coherence tomography (OCT). Methods: This prospective study included 60 patients complaining of epiphora due to inflammatory punctual stenosis. They were divided into two groups: Group A (30 patients) treated with a combination of preservative free hydrocortisone sodium phosphate 3.35 mg/mL eye drops, and preservative free artificial tears based on sodium hyaluronate, polyethylene and propylene Glycol; Group B (30 patients) treated with the same preservative free artificial tears only. Thirty normal subjects were included for comparison of pre-treatment anatomical parameters. Before starting treatment, all patients underwent anterior segment assessment including slit lamp examination, measurement of intraocular pressure (IOP), fluorescein dye disappearance test, and measurement of the outer punctum diameter (OPD) by Spectral domain anterior segment OCT. All assessments were repeated at each follow up done at 1 and 3mo later, together with subjective evaluation of patient's satisfaction of the treatment outcome by simple rating questionnaire. Results: Punctual diameter increased significantly with treatment in both groups (P<0.0001); although the widening was more in Group A as compared to group B (16.2% vs 8% of the original punctual size, mean difference of 28.933 µm, P=0.0076). Subjective satisfaction with treatment outcome was also better in group A (70% vs 40%, Chi-square P=0.0397). Conclusion: A combination of preservative free steroid eye drops and artificial tears causes significant widening of inflammed stenotic punctae and improvement of the associated epiphora.
... Anatomically, acquired punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded and also can be accompanied by canalicular ductal stenosis. 1,2 . Defining an anatomical clear cut-off value for punctal stenosis is difficult due to wide variations in patients' demographics. ...
... Clinically, punctal stenosis is defined as a punctum size restricting tear drainage in the absence of distal tear drainage abnormalities. 2 Acquired punctal stenosis can be involutional, inflammatory, infectious or idiopathic. 3,4 Inflammatory endogenous causes include chronic blepharitis, dry eye disease and ocular cicatricial pemphigoid. ...