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. 2021 May 31;10(1):18-23.
doi: 10.51329/mehdiophthal1417. eCollection 2021 Spring.

Acquired symptomatic external punctal stenosis: a tertiary referral center study

Mona Nassief  1 , Omar Kh M Alduwailah  2 , Nancy M Lotfy  3
Affiliations

Acquired symptomatic external punctal stenosis: a tertiary referral center study

Mona Nassief et al. Med Hypothesis Discov Innov Ophthalmol. .

Abstract

Background: To report the prevalence of acquired symptomatic external punctal stenosis (EPS) in a tertiary referral center in Kuwait, and to study the associated risk factors, etiologies, and management outcomes.

Methods: This prospective interventional hospital-based study was performed at the Farwaniya governmental hospital in Kuwait between November 2018 and November 2019. All patients were referred to the oculoplastic clinic with symptomatic epiphora, age > 18 years, epiphora Munk score ≥ 0, tear film meniscus ≥ 2 mm, and punctum with grade ≤ 2 (smaller than normal size, but recognizable) were included. Eclusion criteria were congenital causes of epiphora, previous eyelid surgeries, and traumatic or neoplastic causes of punctal or canalicular obstruction.

Results: A total of 418 patients with symptomatic epiphora, who were referred to our oculoplastic clinic, were enrolled in our study. The prevalence of EPS was 70.3%. Eamination of the puncta revealed different shapes, including tangential, pinpoint, elevated, slit-shaped, horse shoe-shaped, and membranous puncta, with the tangential type accounting for the greatest proportion (65.3%). Bilateral punctal stenosis was observed in 206 patients (70.1%) and unilateral involvement in 88 patients (29.9%). Dilatation and syringing were performed for all puncta upon diagnosis, and repeated dilatation was performed for 225 puncta (32.7%). Placement of a Mini-Monoka tube was performed in 11 puncta (1.6%).

Conclusions: EPS was a common cause of symptomatic epiphora in our study. Aging and female sex were identified as common risk factors. Most etiological factors of EPS were associated with a pathophysiological inflammatory mechanism. For exact estimates of its prevalence, a population-based study is necessary in future.

Keywords: Kuwait; chronic blepharitis; dry eye; epiphora; mini monoka; prevalence; punctal stenosis.

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Conflict of interest statement

None.

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