Acquired External Punctal Stenosis: Surgical Management and Long-Term Follow-Up

Abstract

The use of a monocanalicular Mini Monoka stent together with a one-snip punctoplasty is helpful to prevent the recurrence of punctal stenosis in the healing phase and addresses the associated internal punctal and canalicular stenosis.

Prevalence and Associations of External Punctal Stenosis in a General Population in Spain

“…E xternal punctal stenosis (EPS) is a disorder of the ocular surface that may cause epiphora because of the blockage of the tear drain and increased inflammation, which in some cases requires the insertion of lacrimal plugs or even surgery 1,2 to restore tear film clearance. The frequency of EPS in clinical practice is high, 3,4 and case series and a few hospital-based studies have linked several factors including infections, inflammations, lid malpositions, and certain medications to this condition.…”

Outcomes of rectangular 3-snip punctoplasty in acquired punctal stenosis: is there a need to be minimally invasive?

“…Several modalities described in the literature include punctal dilatation, 1-snip punctoplasty, 2-snip punctoplasty, triangular 3-snip punctoplasty, rectangular 3-snip punctoplasty, 4-snip punctoplasty, punctal punching with Kelly's or Riess punch, punctoplasty with mitomycin-C, and inserting perforated punctal plugs, self-retaining bicanalicular stents, or mini-monoka. [5][6][7][8][9][10][11][12][13] Three-snip procedures in its modern form was described by Thomas in 1951. 14 The triangular 3-snip is a more traditional way with one cut in the vertical canaliculus, one in the horizontal canaliculus and one cut at the base.…”

“…1 The etiopathogenesis remains elusive but is attributed to a common mechanism of chronic inflammation resulting in fibrosis and subsequent stenosis. [2][3][4] In order to facilitate uniform protocols of assessment, Kashkouli et al 4,5 proposed a grading system for the puncta based on its size and shape. However, there are no uniform acceptable guidelines for the management of punctal stenosis.…”

Suture-assisted punctoplasty

“…4,5 Although the punctoplasty is a relatively simple surgical procedure, there is a considerable variation in the surgical techniques described to perform a punctoplasty; these include 1-snip, 2-snip, and 3-snip punctoplasty techniques, 1,4,6 punctal punching, 3 adjuvant use of mitomycin C, 7 perforated punctual plugs, 8 and use of mini-Monoka stents. 9 In 1853 Bowman described the 1-snip punctoplasty, which had a high rate of failure attributable to reapproximation of the adjacent raw cut edges. 6 To solve this problem, a 2-snip variation of the surgery was suggested by Jones in 1962.…”