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Punctal Stenosis

  • Erfan El-GazayerliEmail author
Chapter
  • 59 Downloads

Abstract

Lacrimal punctal stenosis, despite being a common cause of epiphora, is frequently missed and often misdiagnosed. Moreover, available management guidelines are inconsistent and lack integrity. This chapter provides an understanding review of the pathophysiology, etiology, clinical grading and diagnosis of this punctal disorder. It also offers an integrated management approach, underlining relevant and valid treatment modalities for the different grades of this disease.

Keywords

Punctal stenosis Dacryotoxicity Snip procedures 

Notes

Acknowledgements

The author wishes to thank Moataz Dabees, fellow oculoplastics at Magrabi eye hospital, Cairo, Egypt for his contribution in research and editing work.

Suggested Readings

  1. 1.
    Kakizaki H, Takahashi Y, I waki M, et al. Punctal and canalicular anatomy: implications for canalicular occlusion in severe dry eye. Am J Ophthalmol. 2011;153(2):229–37.Google Scholar
  2. 2.
    Ball JM. Modern ophthalmology: a practical treatise on the anatomy physiology and disease of the eye. 5th ed. Philadelphia, PA: FA Davis; 1926.Google Scholar
  3. 3.
    Saude T Ocular Anatomy and Phisiology. Oxford, UK: Blackwell Scientific Publications; 1993.Google Scholar
  4. 4.
    Mainville N, Jordan DR. Etiology of tearing, a retrospective analysis of referrals to a tertiary care oculoplastic practice. Ophthal Plast Reconstr Surg. 2011;27(3):155–7.PubMedGoogle Scholar
  5. 5.
    Bukhari A. Prevalenceof punctal stenosis among ophthalmology patients. Middle East Afr J Ophthalmol. 2009;16(2) :85–7.Google Scholar
  6. 7.
    Takahashi Y, Kakizaki H, Nakano T, Asamoto K, Ichinose A, Iwaki M. Anatomy of vertical lacrimal canaliculus and lacrimal punctum: a macroscopic study. Ophtalmis Plastic Reconstr Surg. 2011; 27(5): 384–6.Google Scholar
  7. 8.
    Carter KD, Nelson CC, Martonyl CL. Size variation of the lacrimal punctum in adults. Ophthal Plast Reconstr Surg. 1988;4(4):231–3.CrossRefGoogle Scholar
  8. 9.
    Patel S, Wallace I. Tear meniscus height, lower punctum lacrimale and the tear lipid layer in normal aging. Optom Visi Sci. 2006;83(10):731–9.CrossRefGoogle Scholar
  9. 10.
    Yom KC, Jeong SK, Park YG. Study of lacrimal punctal size in normal adults. J Korean Ophthalmol Soc. 1997;38:1916–20.Google Scholar
  10. 11.
    Olver J, Part A. Colour Atlas of lacrimal surgery. London, UK: Butterwoth- Heinemann; 2001.Google Scholar
  11. 12.
    Hu W, Zhang Y, Tighe S, Zhu YT, Li GG. A new isolation method of human lacrimal canaliculus epithelial stem cells by maintaining close association with their niche cells. Int J Med Sci. 2018;15(12):1260–7.  https://doi.org/10.7150/ijms.27705.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 13.
    Port AD, Chen YT, Lelli GJ Jr. Histopathological changes in punctal stenosis. Ophthal Plast Reconstr Surg. 2013;29:201–4.CrossRefGoogle Scholar
  13. 14.
    Ali MJ, Mishra DK, Baig F, et al. Punctal stenosis: histopathology, immunology and electron microscopic features- a step toward unraveling the mysterious etiopathogenesis. Ophthal Plast Reconstr Sur. 2015;31:98–102.CrossRefGoogle Scholar
  14. 15.
    Pakdel F, Khashkouli MB. Lacrimal Drainage Obstruction Associated with Topical and Systemic Medications. J Ophthalmis Vis Res. 2009;4(4):270–1.Google Scholar
  15. 16.
    Kashkouli MB, Beigi B, Murthy R, Astbury N. Acquired External punctal stenosis: etiology and associated findings. Am J Ophthalmol. 2003;136(6):1079–84.CrossRefGoogle Scholar
  16. 17.
    O’Donnell FE. Medical ectropion: association with lower lacrimal obstruction and combined management. Ophthalmic Surg. 1986;17(9):573–6.PubMedGoogle Scholar
  17. 18.
    Caesar RH, Mc Nab AA. A brief history of punctoplasty. The three snip revisited. Eye. 2005;19:16–8.Google Scholar
  18. 19.
    Chak RH, Irvine F. Rectangular 3 snip punctoplasty outcomes: preservation of lacrimal pump in punctoplasty surgery. Oohthal Plast Reconstr Surg. 2009;25:134–5.CrossRefGoogle Scholar
  19. 20.
    Shahid H, Sandhu A, Keenan T, Pearson A. factors affecting outcomes of punctoplasty surgery: a review of 205 cases. Br J Ophthalmol. 2008;92:1689–92.CrossRefGoogle Scholar
  20. 21.
    Konug O, Urgan Cioglu B, Unal M. long term success rate of perforated punctal plugs in the management of acquired punctal stenosis. Ophthal Plast Reconstr Surg. 2008;24:399–402.CrossRefGoogle Scholar
  21. 22.
    Hussein RN, Kanani H, Mc Mullan T. use of minimonoka stents for punctal and canalicular stenosis. Br J Ophthalmol. 2012;96:671–3.CrossRefGoogle Scholar
  22. 23.
    Carrim ZI, Liolaios VI, Vize CJ. Punctoplasty with a Kelly punch. Ophthalmol Plast Reconstr Surg. 2011;27:397–8.CrossRefGoogle Scholar
  23. 24.
    Eldelstein JP, Reiss G. introducing the Reiss punctal punch. Arch Ophthalmol. 1991;109:1310.CrossRefGoogle Scholar
  24. 25.
    Chalvatzis NT, Tzamalis AK, Mavrikakis I, Tsinopoulos I, Dimitrakos S. Self-retaining bicanaliculus stents as an adjunct to 3 snip punctoplasty in management of upper lacrimal duct stenosis: a comparison to standard 3- snip procedure. Ophthal Plast Reconstr Surg. 2013;29:123–7.CrossRefGoogle Scholar
  25. 26.
    Pratt DV, Patrinely JR. Reversal of iatrogenic punctal and canalicular occlusion. Ophthalmology. 1996;103:1493–7.CrossRefGoogle Scholar
  26. 27.
    Lyons CJ, Rosser PM, Welham RA. The management of punctal agenesis. Ophthalmology. 1993;100(12):1851–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Oculoplastic Surgery UnitMagrabi Eye HospitalCairoEgypt

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