Punctoplasty

Patients should be evaluated and deemed appropriate for such surgical intervention. Patients with isolated punctal stenosis resulting in excessive tearing, or epiphora, can be considered as candidates for this procedure. The procedure is typically performed on the lower eyelid puncta. The distal lacrimal drainage apparatus must be intact. Patients should be educated about the risks and benefits of the procedure, including alternatives. Schirmer test should be performed because real cause of epiphora may be unrecognized reflex hypersecretion from ocular surface disease. Those with prior failed punctoplasty, ongoing inflammatory process, or an element of canalicular stenosis should be considered for concomitant nasolacrimal stenting procedures.