Bicanalicular Silicone Intubation for the Management of Punctal Stenosis and Obstruction in Patients With Allergic Conjunctivitis

Abstract

Purpose: To evaluate the use of bicanalicular silicone intubation for the management of punctal stenosis and obstruction in patients with allergic conjunctivitis. Methods: A retrospective interventional case series of patients with acquired epiphora due to stenotic or obstructed puncta as a result of allergic conjunctivitis was performed. Punctal dilation and bicanalicular silicone intubation were performed in all patients. Munk Scale for grading of epiphora along with grading of fluorescein dye disappearance test was used to evaluate the functional improvement. Grading of punctal stenosis using Kashkouli’s grading system was applied to evaluate the anatomical improvement. Patients having canalicular or nasolacrimal duct obstruction, punctal stenosis, and obstruction due to other causes were excluded. Results: Fifty-one patients met the inclusion criteria with male-female ratio of 1:1.55 and an average age of 46 years at presentation. High patient tolerances without complications with the use of tubes were reported. Significant improvement 6 months after tube removal in comparison to preoperative period was found with anatomical and functional success rate of 91.83% and 87.75%, respectively. Two patients had a recurrence of the punctal stenosis many months after stent removal because of the early tube prolapse and exacerbation of the allergic conjunctivitis. Conclusions: Bicanalicular silicone intubation seems to be a well-tolerated and effective tool in the management of acquired punctal stenosis or obstruction secondary to allergic conjunctivitis. Bicanalicular silicone intubation appears to be a good option as patients with allergic conjunctivitis typically present with bilateral involvement of both puncti.

The Role of Th17 Cells and IL-17 in Th2 Immune Responses of Allergic Conjunctivitis

“…GPC is a disease related to contact lenses wear, which is not considered any longer as an allergic disorder but still included within the allergic conjunctivitis. SAC and PAC do not have discernible difference in the symptoms such as ocular itching, hyperaemia, dry eye, redness, and lid swelling, and also, tearing, mucous discharge, and burning may occur [20,[24][25][26]. ey all belong to the acute type of allergic conjunctivitis.…”

Lacrimal stenting versus three-snip punctoplasty for treatment of punctal stenosis or occlusion: An open-label, randomized clinical trial

“…Ideal stents should be inert, flexible, have a soft external surface, be self-retaining, inexpensive, widely accessible, user-friendly, and should not induce mechanical damage to contiguous soft tissues. Silicon tubes have most of the above-mentioned properties [17][18][19]. We used bicanalicular silicon tube insertion in 12 eyes, and removed them after 6 months.…”

The spectrum of allergic ocular diseases

“…63 Patients with chronic ocular allergy may develop punctal stenosis either secondary to uncontrolled conjunctival inflammation or owing to membrane formation over the punctum from chronic use of topical medications. 2,114,115 In patients with PAC with relapsing symptoms and punctal stenosis, mini-monoka stenting and bicanalicular silicone intubation are well tolerated and effective interventions to treat acquired punctal stenosis from allergic conjunctivitis. 2,[114][115][116] Chronic severe VKC and AKC may lead to conjunctival epithelial ingrowth on the cornea, recurrent corneal epithelial defects, and neovascularization, a condition known as limbal stem cell deficiency.…”

“…2,114,115 In patients with PAC with relapsing symptoms and punctal stenosis, mini-monoka stenting and bicanalicular silicone intubation are well tolerated and effective interventions to treat acquired punctal stenosis from allergic conjunctivitis. 2,[114][115][116] Chronic severe VKC and AKC may lead to conjunctival epithelial ingrowth on the cornea, recurrent corneal epithelial defects, and neovascularization, a condition known as limbal stem cell deficiency. 73 A recent study revealed that surgical rehabilitation with procedures such as limbal stem cell transplantation, Boston keratoprosthesis, and superficial keratectomy in patients with advanced ocular surface disease arising from chronic severe AKC has mixed outcomes, with some cases developing visual loss.…”