title: The effect of perforated punctal plugs in the management of acquired punctal stenosis.
abstract: OBJECTIVE
  The objectives of this study were to report the success rates for perforated punctual plug (PPP) in the management of acquired punctual stenosis and to evaluate the factors influencing success rates.
  
  
  METHODS
  This was a retrospective, cross-sectional, comparative study.
  
  
  METHODS
  There were 20 patients.
  
  
  METHODS
  Twenty eyes of 20 patients who underwent PPP implantation for the management of acquired punctual stenosis and punctual obstruction were retrospectively evaluated regarding sex and age of the patients and the duration and severity of epiphora, associated blepharitis, and the success of treatment. In all patients, punctum dilation was performed carefully to prevent damage to the ampulla before the insertion of plugs. Perforated punctual plugs were removed 2 months after insertion.
  
  
  RESULTS
  There were 7 cases of punctal stenosis, 9 cases of membranous obstruction, 2 punctal burns, 1 papilloma, and 1 nevus involving the punctum causing epiphora. The mean age of patients was 41.4 (SD, 3.9) years. The mean interval between the onset of epiphora and PPP implantation was 32.1 (SD, 10.7) months. Associated chronic blepharitis was detected in 13 eyes. Success was achieved in 17 eyes (85%). Patients whose procedures failed were older (67.7 vs 36.8, P = 0.019) and more likely to have blepharitis (100: 23.5%, P = 0.031). Spontaneous plug loss was noted in 4 eyes between the 1- and 2-month follow-up examination. No patients had residual epiphora.
  
  
  CONCLUSIONS
  Perforated punctual plug implantation for the treatment of acquired punctual stenosis and obstruction is very effective. However, careful punctum dilation should be performed, and the patient age and comorbidities should be considered before treatment.
authors.affiliation: From the *Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea; †Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea; and ‡Department of Ophthalmology, Guro Hospital, Korea University College of Medicine, Seoul, Korea.
authors.forename: Minwook
authors.initials: M
authors.lastname: Chang
authors.forename: Soh-Eun
authors.initials: SE
authors.lastname: Ahn
authors.forename: Sehyun
authors.initials: S
authors.lastname: Baek
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001762:Blepharitis / Q000601:surgery; D003251:Constriction, Pathologic / Q000601:surgery; D003430:Cross-Sectional Studies; D003608:Dacryocystorhinostomy; D004106:Dilatation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007765:Lacrimal Apparatus / Q000601:surgery*; D007766:Lacrimal Apparatus Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome