Comparative study between three different modalities for treatment of inflammatory punctal stenosis

Abstract

Background Different modalities were described for the treatment of acquired punctal stenosis. Aim To compare the efficacy of punctal dilation alone, combined punctal dilation with topical medications, and triamcinolone acetonide peri-punctal injection in the treatment of inflammatory punctal stenosis. Patients and methods This prospective, comparative, and interventional study was carried out on 94 eyes of 60 patients aged 30–76 years old, both sexes, with inflammatory punctal stenosis complaining from symptomatic epiphora. Patients were divided into three equal groups: group A (punctal dilation alone), group B (punctal dilation combined with preservative-free steroid eye drops and artificial tears), and group C (peri-punctal triamcinolone acetonide injection). Results There was a significant difference in punctal diameter before and after treatment across all groups. Regarding treatment efficacy, group A had a success rate of 22.22% in cases related to chronic blepharitis, while group B had 75%, and group C had 55.56%. In cases of inflammatory punctal stenosis associated with anti-glaucomatous eye drops, group A had a success rate of 28.57%, group B had 50%, and group C had 42.86%. Patient satisfaction was highest in group B, with 65% reporting satisfaction, compared to 60% in group C and the least satisfied group, group A. Conclusion The optimal treatment for inflammatory punctal stenosis is a combination of punctal dilation with preservative-free steroids and artificial tear drops. Peri-punctal triamcinolone injection is also effective, providing longer-lasting results. Punctal dilation alone is less effective, particularly in severe cases. For stenosis, combined treatments or triamcinolone injections are preferred.