Incidence of Primary Punctal Stenosis in Adult Patients with Epiphora

Abstract

Punctal stenosis is one of the etiologies of epiphora, which is caused by an anatomical narrowing or occlusion of the external opening of the lacrimal canaliculi.(37) Punctal stenosis is graded according to punctal sizes examined under slit-lamp into grade 0 (could not find papilla and punctum), grade 1: Papilla is covered by a membrane (exudative or true membrane), grade 2: Smaller than normal size but recognizable, grade 3: normal, grade 4: Small slit (<2 mm) and grade 5: Large slit (>2 mm).(4) Different etiological factors were implicated, chronic inflammation and gradual fibrotic changes in the ostium of the external punctum followed by progressive occlusion of the duct in response to various noxious stimuli appears to be the current proposed mechanism for acquired punctal stenosis.(40) The aim of this study was to assess the incidence of punctal stenosis in adult patients with epiphora attending outpatient’s ophthalmology clinic at Ain Shams University Hospital during the months of January and February 2020. Thirty-one patients, out of 1800 patients attending the Outpatient Ophthalmology Clinic during the study period had epiphora with incidence of 1.6 %. Incidence of punctal stenosis was reported to be 68.4%. Other causes of epiphora were canaliculitis (3.5%), chronic dacrocystitis (5.3%), lacrimal sac mucocele (1.8%) and lower lid laxity (21.1%).