Role of preservative free steroid eye drops in treatment of inflammatory punctal stenosis guided by anterior segment optical coherence tomography

Abstract

Aquired inflammatory punctal stenosis is a disease commonly presented with epiphora and most common cause is long term treatment with preservative containing topical eye drops. The inflammation causes a decrease in the clearance of the medication and preservative, and their continued use will result in more inflammation and stenosis, and therefore a longer clearance time resulting in a higher concentration and longer transit time, leading to a vicious cycle. The inflammation and fibrosis of the lacrimal drainage system causes extensive fibrous adhesions that obstruct the canaliculi and lacrimal sac. These drugs and similar ones cause damage to the mucosal lining, which occasionally may cause permanent damage to the lacrimal system. The ocular abnormalities are most likely secondary to the inhibition of cellular proliferation in the conjunctiva, cornea, and the eyelid, that generally occurs within days to weeks of the initiation of treatment. These complications will usually resolve after the treatment is completed.