Management of Lower Punctal Stenosis.
Condition: Epiphora
MeSH terms: Lacrimal Apparatus Diseases; Constriction, Pathologic
Study type: Interventional

Summary: 
      a prospective non-randomized study conducted upon 24 patients with severe lower punctual
      stenosis (grade 0 according to Kashkouli scale) attending at Menoufia University hospitals.
      The upper punctum and canaliculus were patent. All patients were complaining of epiphora and
      had a thorough ophthalmological examination including dye disappearance test, and slit-lamp
      examination. Pigtail probe was used from patent upper punctum to detect the lower stenosed
      punctum which was opened with a scalpel. Syringing of the lower lacrimal passages was done to
      confirm its patency and self retaining silicone bicanalicular stent was inserted. The
      silicone tube was left in place for 6 months before it was removed. Patients were then
      followed up for 1 year after the surgery.
    

Detailed description: 
      This is a prospective non-randomized study which was conducted upon 24 patients with total
      lower punctual occlusion attending at Menoufia University hospitals in the period from
      January 2014 to January 2018. Ethics approval from the institutional review board was
      obtained, and a written informed consent was taken from every patient according to the
      Declaration of Helsinki.

      All patients of the study were complaining of epiphora and had a thorough ophthalmological
      examination including dye disappearance test, and slit-lamp examination. The dye
      disappearance test was performed with a drop of 2% fluorescein sodium and assessment after 5
      minutes of the remaining dye in the tear meniscus was done and results were graded.

      Surgical procedure

      All operations were done under general anesthesia and were performed by two authors (SSM,
      KES). The authors performed lacrimal probing and syringing test through the normal punctum to
      exclude concomitant occluded common canaliculus or nasolacrimal duct. The pigtail probe was
      passed through the canalicular system from the normal punctum to the occluded aspect. When
      the tip of the pigtail probe was positioned near the occluded punctal area, the surgeon
      pushed the area to be tented with the pigtail probe. After they advanced the pigtail probe
      back and forth several times until they could locate the correct position of the occluded
      punctum, the authors incised the tented area with a scalpel No. 11 to make a new punctal
      opening.

      To ensure punctal and canalicular patency, syringing was repeated through the perforated
      punctum. To prevent re-occlusion of punctal opening, a self retaining bicanalicular tube
      (FCI®; Paris, France) was inserted through the normal and perforated puncti.

      The silicone tube was left in place for 6 months before it was removed. Patients were then
      followed up for 1 year after the surgery (6 months after removal of the tube). During the
      follow-up period, the authors investigated the improvement of subjective epiphora symptoms
      based on Munk score, fluorescein disappearance test, maintenance of newly formed punctal
      opening, and incidence of complications.
    

Intervention name(s): insertion of self retaining bicanalicular stent
Intervention type(s): Procedure
Intervention description(s): The pigtail probe was passed through the canalicular system from the normal punctum to the occluded aspect. When the tip of the pigtail probe was positioned near the occluded punctal area, the surgeon pushed the area to be tented with the pigtail probe. After they advanced the pigtail probe back and forth several times until they could locate the correct position of the occluded punctum, the authors incised the tented area with a scalpel No. 11 to make a new punctal opening.
To ensure punctal and canalicular patency, syringing was repeated through the perforated punctum. To prevent re-occlusion of punctal opening, a self retaining bicanalicular tube (FCI®; Paris, France) was inserted through the normal and perforated puncti
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: pigtail; punctal stenosis; bicanalicular