The effect of perforated punctal plugs in the management of acquired punctal stenosis

OBJECTIVE: The objectives of this study were to report the success rates for perforated punctual plug (PPP) in the management of acquired punctual stenosis and to evaluate the factors influencing success rates. DESIGN: This was a retrospective, cross-sectional, comparative study. PARTICIPANTS: There were 20 patients. METHODS: Twenty eyes of 20 patients who underwent PPP implantation for the management of acquired punctual stenosis and punctual obstruction were retrospectively evaluated regarding sex and age of the patients and the duration and severity of epiphora, associated blepharitis, and the success of treatment. In all patients, punctum dilation was performed carefully to prevent damage to the ampulla before the insertion of plugs. Perforated punctual plugs were removed 2 months after insertion. RESULTS: There were 7 cases of punctal stenosis, 9 cases of membranous obstruction, 2 punctal burns, 1 papilloma, and 1 nevus involving the punctum causing epiphora. The mean age of patients was 41.4 (SD, 3.9) years. The mean interval between the onset of epiphora and PPP implantation was 32.1 (SD, 10.7) months. Associated chronic blepharitis was detected in 13 eyes. Success was achieved in 17 eyes (85%). Patients whose procedures failed were older (67.7 vs 36.8, P = 0.019) and more likely to have blepharitis (100: 23.5%, P = 0.031). Spontaneous plug loss was noted in 4 eyes between the 1- and 2-month follow-up examination. No patients had residual epiphora. CONCLUSIONS: Perforated punctual plug implantation for the treatment of acquired punctual stenosis and obstruction is very effective. However, careful punctum dilation should be performed, and the patient age and comorbidities should be considered before treatment.