Acquired symptomatic external punctal stenosis: A tertiary referral center study

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 ۲۰۱۸ and November ۲۰۱۹. All patients were referred to the oculoplastic clinic with symptomatic epiphora, age > ۱۸ years, epiphora Munk score equal or more than ۰, tear film meniscus equal or more than ۲ mm, and punctum with a grade equal or less than ۲ (smaller than normal size, but recognizable) were included. Exclusion criteria were congenital causes of epiphora, previous eyelid surgeries, and traumatic or neoplastic causes of punctal or canalicular obstruction. Results: A total of ۴۱۸ patients with symptomatic epiphora, who were referred to our oculoplastic clinic, were enrolled in our study. The prevalence of EPS was ۷۰.۳%. Examination 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 (۶۵.۳%). Bilateral punctal stenosis was observed in ۲۰۶ patients (۷۰.۱%) and unilateral involvement in ۸۸ patients (۲۹.۹%). Dilatation and syringing were performed for all puncta upon diagnosis, and repeated dilatation was performed for ۲۲۵ puncta (۳۲.۷%). Placement of a Mini-Monoka tube was performed in ۱۱ puncta (۱.۶%). Conclusion: 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.