ABSTRACT

The punctum, which is the initial part of the lacrimal excretion system, is a small circular or oval aperture that is placed on the papilla, a small protuberance on the nasal parts of the upper and lower eyelids. Its diameter is 0.3 mm. The upper punctum is 5-6 mm from medial commissura and localized 0.5 mm medial to the lower punctum. The upper and lower punctums appose each other when the eyelids are closed. The punctum turns a little posterior to contact with tears. So to reveal it, we should turn the free edge of the eyelid a little outward. If epiphora exists without anatomic obstruction of the lacrimal passage, it is named ‘functional epiphora’. Anatomic defects of the eyelids and punctum stenosis are causes of functional epiphora. In this study, we aimed to evaluate the effectiveness and long-term results of one-snip punctoplasty and monocanalicular stent technique in patients who presented with epiphora due to punctum stenosis.

Our patients with punctum stenosis, who had one-snip punctoplasty between 2007-2011, were investigated retrospectively. The cases that were followed-up less than 6 months and the patients with canalicular and nasolacrimal obstruction were excluded from investigation. Patients that suffered from epiphora, whose lacrimal irrigation was successful, and patients whose punctum dilatation failed were included. All patients were examined on the biomicroscope and tested by lacrimal irrigation, Schirmer and Fluorescein Clearance Test preoperatively and postoperatively. One-snip punctoplasty and monocanalicular stent were performed under local anesthesia in all cases. Amoxycilline+clavulanic acid 1g (2x1), oral naproxen sodium (2x1), tobramycine eye-drop (5x1) and fluorometelon eye-drop (4x1) were prescribed to the patients for one week. The patients were followed-up on 1., 3. day, 1.,2. week and 1. month and then once a month. Postoperatively on the 3. day, the silicone stent was withgrawn. The cases that had no epiphora postoperatively were considered successful.

Fifty-seven eyes of 35 patients were operated on. The mean age was 66.7years (37-89). 23 (65.7%) of patients were female, 12 (34.3%) were male. The mean follow-up time was 10.2 months (6-24). In 89.5% of eyes (51) one-snip punctoplasty was successful. In 5 of 6 patients, where we failed, 3-snip punctoplasty was a successful surgical technique. The one patient whose secondary surgery was a failure, was put on a silicone perforated plug.

Epiphora is considered as a discomfort and it is a symptom that depresses patients. As our patients’ mean age was 66.7 (37-89), we can say that punctum stenosis occurs especially on older people. Patients can be operated on with one of these easy and succesful punctoplasty techniques. In recent years, perforated silicone plugs have been in use. The perforated silicone plug is a noninvasive and easy technique. Therefore, it can replace punctoplasty in the coming years. In conclusion, one-snip surgical tecnique’s main advantage is its easy and more rapid use and it is successful in punctum stenosis. However, more follow-up time and more comparative studies are needed. (JAREM 2011; 1: 49-51)

Keywords: Punctum stenosis, one-snip, monocanalicular stent