الفهرس 
Anatomy of the lacrimal drainage systemOnly 14 pages are availabe for public view
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Abstract
Punctum stenosis is one of the frequent causes of epiphora
besides canalicular or nasolacrimal duct obstruction. It can be
congenital or acquired. Acquired punctum stenosis may result from
inflammatory or infectious eye disease, systemic or topical drug
toxicity, lid malposition, different forms of trauma, tumors or ageing
changes.
The treatment options are punctal dilatation, 1-snip
punctoplasty, 2-snip punctoplasty, triangular TSP, rectangular TSP, 4-
snip punctoplasty, punctal punching with Kelly’s or Riess punch,
punctoplasty with mitomycin-C, and inserting perforated punctal
plugs, self-retaining bicanalicular stents, or mini-monoka.
The triangular TSP in its traditional form is based on one cut in
the vertical canaliculus, one in the horizontal canaliculus and one cut
at the base. The current study examines the role of placing 3
interrupted sutures at posterior wall of the ampulla after triangular
TSP in achieving successful outcomes and preventing reapproximation
of the cut ends in cases of acquired lower punctal
stenosis.
This is a prospective randomized study which included 40
eyelids of 24 patients with acquired lower punctal stenosis grade 1 or
grade 2 according to Kashkouli scale distributed in two groups, group
A treated by triangular TSP followed by three interrupted sutures at
the ampulla and group B treated by conventional triangular TSP. They
were recruited from the outpatient clinic of Ophthalmology
Department, Menoufia University Hospital.
All patients underwent detailed ophthalmological assessment
including external examination to exclude other causes of epiphora,
slit lamp examination for Punctal orifices position, shape and grading
of stenosis, diagnostic probing and lacrimal irrigation to make sure of
patency of lacrimal passages and nasal examination.
Data were collected, revised, verified, coded, then entered PC
for statistical analysis done by using SPSS version 20.
The study had achieved a reasonable success in improving
epiphora in (80%) of patients in group A and in (60%) in patients in
group B after follow up period of 6 months.
The only Complication occurred was foreign body sensation
that was felt in 100% of eyes in group A during the early
postoperative period and disappeared after one week when stiches
were removed. This complaint was not present in patients of the other
group.