Different surgical techniques applied in the treatment of punctum obstruction and the retrospective evaluation of the results

Punctal stenosis refers to narrowing or complete obstruction of the external opening of the tear duct. It can be congenital or acquired. The most common cause is chronic blepharitis. Infections, aging, inflammation, topically applied drugs, systemic chemotherapeutic drugs are other causes. The aim of treatment is to provide adequate punctal opening and to preserve lacrimal pump function. There is no gold standard treatment method yet. In our study, the pre- and post-surgical findings of patients who underwent different surgical techniques for punctal stenosis were examined retrospectively. 259 eyes of 142 patients were included in our study. The surgical methods we apply; triple incision punctoplasty, triple incision punctoplasty + 5FU-MMC, micropunch punctoplasty, micropunch punctoplasty + 5FU-MMC, micropunch punctoplasty + TA, bicanalicular pigtail assisted silicone intubation, bicanalicular pigtail assisted silicone intubation + 5FU-MMC and punctoconjunctival flep technique. The mean age of 142 patients included in our study was 65,08±14,08 years. 52,1% of the patients were female and 47,9% were male. Bilateral surgery was performed in 82,4% (117 patients) of the patients and unilateral surgery was performed in 25 patients. The most frequently performed surgery is Triple incision + 5FU-MMC. After primary procedures, restenosis was seen in 18 eyes in the upper punctum and in 39 eyes in the lower punctum. Restenosis development time is most common in the first 1 month for the upper and lower punctum. After the primary procedures, the epiphora was completely resolved in 76,1% of the eyes and partially resolved in 21,6%. Secondary and tertiary procedures were performed on patients whose epiphora partially resolved. When the surgical method groups were compared, no significant difference was observed in terms of both anatomical and functional success for the upper and lower punctum. Punctal stenosis is a disease caused by different etiological factors that can cause epiphora. If the patient is symptomatic, appropriate surgical planning should be performed after the risk factors are well evaluated.