Punctal Disorders, Malpositions, and Management

  • Moisés Enghelberg
  • Cat Nguyen BurkatEmail author


The superior and inferior lacrimal puncta are the gatekeepers to the lacrimal excretory system. The relationship of the puncta to the ocular surface and the tear lake is paramount for proper functioning of the lacrimal apparatus. Proper clinical evaluation of the anatomy is outlined, including important considerations of punctal patency and apposition to the globe. The role and potential complications of punctal plugs for dry eye are also discussed. Congenital, acquired, and iatrogenic causes of punctal disorders are outlined, with surgical management highlighted for the most common conditions that distort the structure and function of the lacrimal puncta.


Punctal stenosis Imperforate punctum Conjunctivochalasis Punctal plugs Punctal ectropion Floppy eyelid syndrome Medial spindle conjunctivoplasty Punctoplasty 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyLarkin Community HospitalSouth MiamiUSA
  2. 2.Department of Ophthalmology and Visual SciencesUniversity of Wisconsin-MadisonMadisonUSA

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