Treatment of Lacrimal Punctal Stenosis With a One-Snip Canaliculotomy and Temporary Punctal Plugs

To the Editor. —Lacrimal punctal stenosis can result from numerous disorders. Infectious agents such as herpes simplex, herpes zoster, andChlamydia trachomatishave been noted to cause punctal stenosis as have topically and systemically administered chemotherapeutic agents.1Systemic conditions, including porphyria cutanea tarda, and irradiation have been associated with punctal stenosis.2Aging changes and tissue atrophy can cause the dense fibrous structure of the punctum to become less resilient and the surrounding orbicularis fibers to become atonic, resulting in punctal stenosis. Patients with symptoms of lacrimal punctal stenosis sometimes respond to punctal dilation, and this is a good initial procedure. The Jones one-snip procedure is probably used most often as a secondary procedure for punctal stenosis.3Often the one-snip procedure does not produce a patient orifice large enough to allow tears to drain into the canaliculus. This correspondence describes the use of punctum plugs after a one-snip