Outcomes of Punctal Dilatation With Monocanalicular Stent for the Treatment of Punctal Stenosis

Purpose: To discuss the outcomes of nonincisional punctal dilatation and monocanalicular stent intubation in patients with acquired punctal stenosis. Methods: Retrospective interventional study of patients with symptomatic punctal stenosis over a study period of 4 years (July 2018–July 2022). All patients underwent nonincisional punctal dilation with monocanalicular stenting at 2 tertiary institutes in India and the United States. Procedures were performed as an office procedure with local anesthesia. Topical antibiotics and tapering doses of topical steroids were prescribed in the postoperative period. Stent extubation was done at 4 to 6 weeks. A minimum follow-up of 6 months postoperatively was required to be included in the study. Anatomic success was defined as a patent grade 3 punctum, while functional success was defined as absent or only occasional epiphora (Munk ≤ 1). Results: A total of 198 puncta of 163 patients were included in the study. About 71.8% of patients were women, and the mean age was 53 years (range: 12–82 years). At a mean follow-up of 9.1 months (range: 6–60 months), a significant postoperative improvement in the Munk score (3.71–1.49, p < 0.01) was noted. At postoperative month 6, anatomic success was achieved in 189 (95.5%) puncta, and functional success was achieved in 185 (93.4%) puncta. Recurrent stenosis was noted in 16 (8%) puncta. Conclusion: Nonincisional punctal dilation with a monocanalicular stent demonstrates high anatomical and functional success rates and low restenosis rate, while preserving the punctal integrity and lacrimal pump function.