Snip punctoplasty







Table 63.1

Indications for surgery







Punctal stenosis
Symptomatic epiphora


Table 63.2

Preoperative evaluation













Probing and irrigation of canaliculi and lacrimal system
Assess for co-existent punctal ectropion
Rule out any conjunctival cicatrizing disorder
Assess lower eyelid laxity
Prior eyelid, facial surgery or trauma


Introduction


Punctal stenosis often occurs in conjunction with punctal ectropion. Punctal stenosis may be one of the first signs of the spectrum of lower eyelid ectropion, which first begins with the medial aspect of the eyelid and then involves the entire margin. Punctal stenosis also may occur as part of conjunctival cicatrizing disorders. Ocular cicatricial pemphigoid, Stevens–Johnson syndrome, and pseudo-pemphigoid can all affect the puncta and may cause progressive stenosis that is difficult to manage.


In patients with isolated punctal stenosis, snip punctoplasty can be performed as an in-office procedure or in conjunction with other lower eyelid procedures. Our preferred approach is to use a Kelly Descement punch to perform the punctoplasty. This allows more precise and controlled enlargement compared to the classic three-snip punctoplasty. Placement of silicone stents at the time of punctal stenosis can also improve long-term patency ( Chapter 60 ). Canalicular stenosis and nasolacrimal duct stenosis, however, may be co-existent and, if present, should be also addressed appropriately. After dilation of the puncta, probing and irrigation are essential to diagnose and treat associated lacrimal obstructions.

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May 16, 2019 | Posted by in Reconstructive surgery | Comments Off on Snip punctoplasty
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