Efficacy of 3-Snip Posterior Rectangular Punctoplasty in the treatment of acquired external punctal stenosis

Purpose: To assess the efficacy of 3-snip posterior punctoplasty in the treatment of acquired external punctual stenosis. Study design: A retrospective noncomparative interventional study. Methods: Fifty two (52) eyes of forty one (41) patients with symptoms of acquired external punctal stenosis underwent conventional 3snip posterior rectangular punctoplasty as an outdoor procedure by a single surgeon. Detailed history was taken and subjective grading of epiphora was done by Munk scale. The size of punctum and tear meniscus height was determined on slit lamp examination. Dye disappearance test, tear film breakup time and diagnostic probing and irrigation were performed on each patient before operation. Results: The age ranged between 21 and 88 years (mean, 63.7 years).Twenty seven patients (65.85%) were females and fourteen (34.15%) males. There was a definite increase in tendency with advancing age. The subjective epiphora score and preoperative tear meniscus height were significantly reduced. The grade of punctum size was increased after the surgery and the enlargement was maintained till 8 months postoperatively. The dye disappearance test (DDT) and tear meniscus height also became normal and remained so throughout the postoperative observation period. The success was defined as a subjective improvement in the symptoms. Functional success rate was 80.76% (42 eyes) and anatomical success rate 90.38% (47 eyes).The procedure failed only in 9.62% (5 eyes). Conclusion: The success rate in the review confirms that 3snip posterior punctoplasty is the most logical and reliable procedure in the treatment of acquired external punctual stenosis (AEPS).