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  • Author: John Tong, MD; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: May 20, 2016


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 an obstruction of the drainage system of the eye, resulting in excessive epiphora.



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



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


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[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.



Anatomic 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]


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.

Contributor Information and Disclosures

John Tong, MD 

John Tong, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Cosmetic Surgery, American Association for Pediatric Ophthalmology and Strabismus, American College of Surgeons, American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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