Punctoplasty

Updated: Feb 10, 2017
  • Author: John Tong, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Overview

Background

Punctoplasty can be performed to widen the punctal opening and to improve the drainage of tears in patients with punctal stenosis, which is an abnormal narrowing of the lacrimal punctum, oftentimes caused by inflammation. [1] Punctal stenosis can cause a total or relative obstruction of the drainage system of the eye, resulting in excessive epiphora.

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Indications

Punctoplasty is indicated for excessive epiphora that is secondary to outflow obstruction from punctal stenosis.

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Contraindications

Punctoplasty is contraindicated when excessive tearing is not secondary to punctal stenosis.

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Complication Prevention

Stenosis recurrence can occur if the raw cut edges of the punctum and canaliculi re-approximate and heal together. This is especially true with the 1-snip and 2-snip procedures. Because of this, mitomycin C [2, 3] , punctal plug/Mini Monoka use [4, 5] , self-retaining bicanaliculus stent, [6] and externalization of the canaliculus [7] have been described as adjuncts to try to improve the success rate.

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Outcomes

Anatomical success rates after a punctoplasty have been reported to range from 89%-96%. [8, 4, 9] Functional success rates range from 64%-93%. [10, 11, 8, 4, 9, 12, 13]

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Relevant Anatomy

The lacrimal punctum is the entrance to the nasolacrimal duct system. It is the opening located on the medial eyelid margin of each upper and lower eyelid. Each punctum is positioned in the center of a small mound of tissue called the lacrimal papilla.

The inferior lacrimal punctum is slightly more lateral than the superior punctum. The lacrimal punctum connects to the canaliculus, which has a 2-mm vertical section followed by an 8-mm horizontal section. Where the vertical and horizontal canaliculi join is called the ampulla.

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