title: Acquired external punctal stenosis: surgical management and long-term follow-up.
abstract: OBJECTIVE
  To introduce and assess the results of a long-term follow-up of a one-snip punctoplasty with monocanalicular stent (Mini Monoka) for acquired external punctal stenosis (AEPS) with and without associated internal punctal and canalicular stenosis.
  
  
  METHODS
  Prospective non-comparative interventional case series.
  
  
  METHODS
  Thirty-five eligible patients (53 eyes) with AEPS underwent a horizontal one-snip punctoplasty and Mini Monoka tube insertion by or under supervision of a consultant Oculoplastic surgeon from June 1999 to May 2002. Diagnostic probing and irrigation were performed before operation and after operation at the last follow-up. Patients with canalicular obstruction, nasolacrimal duct stenosis and obstruction, and those with less than 6 months' follow-up were excluded. The Chi-square (X(2)), Fisher's exact, Pearson correlation, and multiple logistic regression analysis tests, with 95% confidence interval when appropriate, were used for statistical analysis.
  
  
  RESULTS
  The age range was 39 to 90 years (mean: 67.2, SD: 11.8, SE: 2). Twenty-seven patients (77.1%) were female. There was a normal canalicular system in 21 (39.6%), lower canalicular stenosis in 10 (18.8%), and internal punctal stenosis in 22 (41.5%) eyes. Postoperative follow-up was from 6 to 41 months (mean: 18.5, SD: 9.2, SE: 1.2). There was a 77.4% complete functional success, 7.5% partial functional success, and 96.2% anatomical success at the last follow-up. The success rate was not significantly different between the eyes with and without preoperative internal punctal and canalicular stenosis (p = 0.4). The lower success rate was significantly correlated with a final abnormal probing and irrigation (p < 0.01).
  
  
  CONCLUSIONS
  The use of a monocanalicular Mini Monoka stent together with a one-snip punctoplasty is helpful to prevent the recurrence of punctal stenosis in the healing phase and addresses the associated internal punctal and canalicular stenosis.
authors.affiliation: Associate Professor, Eye Research Center, Oculoplastic Unit, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohsen Bahmani
authors.initials: MB
authors.lastname: Kashkouli
authors.forename: Bijan
authors.initials: B
authors.lastname: Beigi
authors.forename: Nick
authors.initials: N
authors.lastname: Astbury
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic; D003608:Dacryocystorhinostomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007765:Lacrimal Apparatus; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D055502:Secondary Prevention; D015607:Stents; D016896:Treatment Outcome; D014945:Wound Healing