A Simple Surgical Approach for the Management of Acquired Severe Lower Punctal Stenosis

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.

Comparison between three snip punctoplasty and silicone tube stent in patients with primary punctal stenosis

“…One year following surgery, epiphora was nonexistent (grade 0) in 16 eyes (66.7%) and scarcely evident (grade 1) in 4 eyes (16.7 percent). A statistically significant difference compared to the preoperative epiphora was detected12 .At six weeks, 82 percent of the 77 eyes in patients who underwent punctal dilation with Mini Monoka tube insertion rather than snip operations displayed improvement in epiphora, according to Hussain et al But during the 6-week followup, they observed stent migration in one patient and early stent loss in three patients13 . Following up on 87 eyes, Ali et al discovered that while 82 percent of cases showed complete postoperative symptom relief, 10.3 percent of the eyes experienced epiphora and 5.3 percent had restenosis following punctoplasty14 .…”

Perforated Punctal Plugs for the Management of Acquired External Punctal Stenosis

“…In cases of complete punctal agenesis, interventional treatment with pigtail probe-assisted intubation of both canaliculi using a silicone stent can be considered. This method allows for the localization of the punctal orifice and relatively safe treatment, effectively combating pathological tearing in 66.7% of cases one year after the procedure [12]. Ordinary microsurgical punctoplasty is associated with a high recurrence rate [2].…”

A modified 3D stereophotogrammetry-based distraction test for assessing lower eyelid tension

“…Although several factors can cause eyelid malposition [2] , senile involution can significantly weaken horizontal palpebral traction and eventually decrease lower eyelid tension (LET) [3] . Progressive lower eyelid laxity may cause inappropriate ocular exposure and may have unpleasant effects on the aesthetics of the face [4][5][6] . Eventually, this laxity will need to be corrected surgically [6][7][8] .…”