Lacrimal stenting versus three-snip punctoplasty for treatment of punctal stenosis or occlusion: An open-label, randomized clinical trial

Abstract Background: To compare the short-term anatomical and functional outcomes of, as well as patient satisfaction with, lacrimal stenting and three-snip punctoplasty for the treatment of punctal stenosis or occlusion. Methods: In this open-label, randomized clinical trial, we included ۵۰ eyes of ۳۰ patients diagnosed with punctal stenosis or occlusion. They were randomly allocated to two groups of ۲۵ eyes each, using central telephone randomization. Group A underwent a lacrimal stenting procedure and was subdivided into two subgroups: Group A۱ (۱۳ eyes) received polyvinylpyrrolidone-coated perforated punctal plugs, and Group A۲ (۱۲ eyes) received closed intubation using a bicanalicular silicon tube. Group B included ۲۵ eyes that underwent three-snip punctoplasty. All eyes were examined after ۱ day, ۱ week, ۱ month, ۳ months, and ۶ months. Postoperative anatomical success assessing the punctum size, functional success using the fluorescein disappearance test, and patient satisfaction based on epiphora scoring were recorded. Results: Both study groups were comparable in terms of sex and age distribution. Compared to Group B, Group A had a significantly larger punctum size at one, three, and ۶-month postoperatively (P = ۰.۰۰۹, ۰.۰۱, and ۰.۰۲, respectively). The difference in FDT results was significant between the two groups at all follow-up visits (P = ۰.۰۰۸, ۰.۰۰۰۱, ۰.۰۰۳, and ۰.۰۰۲, at postoperative one week, one-months, three-month, and six-month, respectively). Likewise, patient satisfaction was significantly different between both groups at all follow-up visits (P = ۰.۰۰۷, ۰.۰۰۱, ۰.۰۰۵, and ۰.۰۰۲, at postoperative one week, one-months, three-month, and six-month, respectively). Conclusions: Lacrimal stenting is an effective method for the treatment of punctal stenosis or occlusion. Overall, the FDT results and patient satisfaction outcomes were significantly better.