Aim is to evaluate surgical outcome of Triangular Three-snip Punctoplasty (TSP) with three interrupted sutures and compare it to conventional Triangular Three-snip Punctoplasty (TSP) in treatment of acquired lower punctal stenosis. Methods This prospective study included 40 eyelids of 24 patients with acquired lower punctal stenosis grade 1 or grade 2 were classified in two groups. Group A was treated by triangular 3-snip punctoplasty of the lower punctum followed by three interrupted sutures at the posterior ampulla and group B was treated by conventional triangular 3-snip punctoplasty of the lower punctum. Grade of epiphora and grade of FDDT were measured preoperative then post-operative after 1 week, 1 month, 3 months and 6 months. Success was defined as postoperative improvement of epiphora and FDDT grading with no restenosis to occur. Results from 20 eyelids in group A, 16 cases showed success (80%) with patent puncta, 2 cases (10%) showed no change and 2 cases (10%) showed failure with restenosis. While from 20 eyelids in group B, 14 cases showed success (60%) with patent puncta, 4 cases (20%) showed no change and 4 cases (20%) showed failure with restenosis. Conclusion proposed triangular 3-snip punctoplasty of the lower punctum followed by three interrupted sutures seems to have better results compared to conventional triangular 3-snip punctoplasty of the lower punctum in treatment of grade 1 or 2 lower punctal stenosis.