Bicanalicular silicone intubation can offer relief for punctal stenosis secondary to allergic conjunctivitis

Investigators evaluated the use of bicanalicular silicone intubation for managing punctal stenosis and obstruction in patients with allergic conjunctivitis.

Study design

The study comprised 98 eyes (51 patients); 85 eyes underwent placement using a pigtail probe and 13 eyes had a Crawford tube placed into the nose. Prior to surgery, all patients had severe epiphora (Munk grade 4 or worse) and Kashkouli grade 1 or 2 punctal stenosis. A topical steroid/antibiotic was used for 2 weeks, and a topical antihistamine/mast cell stabilizer was used for at least 3 months.

Outcomes

At least 6 months after tube removal, 86 eyes (88%) showed improved Munk epiphora scores to grade 2 or better. Approximately 92% of patients demonstrated anatomical improvement to a normal-sized grade 3 punctum. Early tube prolapse occurred in 4 patients, and 2 of those patients reported no improvement in tearing.

Limitations

It is possible that the topical medical regimen improved the conjunctivitis and the associated punctal stenosis in some patients. Silicone tube placement is somewhat invasive, and it is possible that simply placing a plug or performing multiple dilations could have achieved a similar effect.

Clinical significance

Bicanalicular silicone intubation appears to mechanically stretch the punctae, resulting in long-term improvement for cases of punctal stenosis associated with allergic conjunctivitis.