Figure - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Content may be subject to copyright.
Grading of epiphora according to Munk score, punctal stenosis according to Kashkouli's grading system and fluorescein dye disappearance time test
Source publication
Aim:
To evaluate the effectiveness of rectangular 3-snip punctoplasty versus punch punctoplasty via Kelly punch with silicone intubation for the management of acquired external punctal stenosis (AEPS).
Methods:
A prospective, randomized, comparative study was performed on 123 eyes of 94 patients with AEPS. Patients were recruited into either gro...
Contexts in source publication
Context 1
... patients were followed up for at least 12mo. At every follow-up point, each case's symptoms were graded according to Munk score (Table 1) [2] . Punctal stenosis was detected on slit-lamp examination, and we categorized the severity of punctal stenosis according to Kashkouli's grading system (Table 1) [1] . ...Context 2
... every follow-up point, each case's symptoms were graded according to Munk score (Table 1) [2] . Punctal stenosis was detected on slit-lamp examination, and we categorized the severity of punctal stenosis according to Kashkouli's grading system (Table 1) [1] . We also performed a fluorescein dye disappearance time test (FDDT), and improved our grading system according to the Zappia score (Table 1) [15] . ...Context 3
... stenosis was detected on slit-lamp examination, and we categorized the severity of punctal stenosis according to Kashkouli's grading system (Table 1) [1] . We also performed a fluorescein dye disappearance time test (FDDT), and improved our grading system according to the Zappia score (Table 1) [15] . A drop of 2% fluorescein was instilled in the conjunctival sac and on the sclera and observed at the end of five minutes and graded in terms of color intensity. ...Similar publications
Purpose of Review
The purpose of this review is to provide an up-to-date summary on the current literature and trends regarding use of the inside-out approach to meniscus repair. Additionally, the paper describes the authors preferred techniques for inside-out meniscus repair utilizing posteromedial and posterolateral exposures.
Recent Findings
Th...
Citations
... Treatment of punctal stenosis ranges from punctal dilation to punctoplasty, depending on the grade of punctal stenosis. Several punctoplasty procedures have been described including one-snip, two-snip, threesnip, four-snip, and Kelly punch punctoplasty [6]. Aside from the ophthalmic surgical advances, adjunct treatments have also been created. ...
Background Punctal stenosis is a progressive constriction of the puncta with resultant epiphora. One of the most effective treatment options is one- to four-snip punctoplasty with or without mitomycin C (MMC).
Aim The aim of this study was to assess the effectiveness of intraoperative MMC in increasing the success rate of three-snip punctoplasty in cases of punctal stenosis.
Patients and methods This is a nonrandomized interventional prospective comparative study that was conducted at the Department of Ophthalmology, Al-Hussein and Bab El Sheria Al-Azhar University Hospitals, Cairo, Egypt. It included 31 eyes of 18 patients who underwent three-snip punctoplasty. The patients were divided into two groups: group 1 (15 eyes), in which MMC was not used during surgery, and group 2 (16 eyes), in which MMC was used intraoperatively for 2 min. Complete ocular examinations were performed in all patients using the slit lamp. Punctal stenosis grading was done as follows: grade 0 (absent punctum), grade 1 (a membrane covering the papilla), grade 2 (less than average size, however, can be recognized), grade 3 (normal), grade 4 (small slit
... and 18.7-93.3%. [11][12][13][28][29][30][31][32][33][34] Assessment of punctoplasty outcomes is complex owing to the lack of a standard definition of punctal stenosis, a large range of punctal size in the normal population, several variations in surgical techniques, different stages of the disease, and poor data on adjunctive modalities. Although significant dysfunctions were reported in short-term, long-term functional epiphora and other defects from performing punctoplasties remain unclear. ...
Punctoplasty is a common procedure in the management of punctal stenosis and was first
described by Sir William Bowman in 1853. Several types of punctoplasty are described, and include
1-snip, 2-snip, triangular 3-snip, rectangular 3-snip and 4-snip procedures. The understanding of the
anatomy and physiology of the punctum has greatly improved in the last decade aided by electron
microscopic and molecular techniques. The use of minimally invasive modalities for primary cases is
on the rise with successful preservation of the physiological functions of the punctum and
canaliculus. The paper reviews the current anatomical and physiological evidence to present an
alternative perspective. Given our evolving understanding, it may be time to debate the practice of
performing routine punctoplasty.
We continue our review of on punctal stenosis by providing a detailed discussion of management modalities, their complications, and outcomes. There is a significant change in the understanding of punctal and peripunctal anatomy, puncto-canalicular junction, and the lacrimal pump mechanisms. While the snip punctoplasty procedures are still practiced, there is an increasing trend toward nonincisional procedures. The nonincisional procedures in select cases appear to be equally effective as the incisional ones. Although simple to use, punctal plugs never became the mainstay of treatment because of design issues and the inability to address the coexisting canalicular stenosis. Placing stents only in the lower punctum in cases of upper and lower punctal stenosis should be discouraged, and management needs to address punctal stenosis and not which punctum is involved. Several types of stents are used in the management of punctal stenosis, mostly based on surgeon's preference. The benefits of adjuvant mitomycin C are uncertain. In view of literature on how stent biofilms can themselves cause chronic inflammation, placing them for prolonged periods should be reviewed and debated. Enhanced understanding of the molecular pathogenesis of punctal stenosis and addressing the current controversies in management would help standardize the therapeutic interventions available in the lacrimal armamentarium.
