الفهرس 
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Abstract
Punctal stenosis is a common cause of epiphora and there are different methods to treat such condition.This study was conducted to compare safety and efficacy between three snip punctoplasty and silicone tube stent in patients with primary punctal stenosis.This study is randomized comparative interventional included 40 cases with primary punctal stenosis who were classified into two groups. 20cases in group 1 underwent three snip punctoplasty and 20case in group 2 underwent Silicone Intubation. Patients were recruited from the Department of Ophthalmology, Mansoura University Hospitals, Egypt. All included cases were subjected to full taking ophthalmic history and full ophthalmological examination, epiphora grading using Munk grading system and fluorescein dye disappearance test.After the surgery, patients were assessed again at the following durations (one day, one week, one month, three month and six month) for evaluation of stability of the silicone tube in the punctum, the punctum is opened, epiphora grading by Munk grading system and fluorescein dye disappearance test.The results of this study showed that:1.There was no statistically significant difference of epiphora grading pre- operative between two studied groups,There were 12 cases 60% with grade 2 epiphora and 8 cases 40% with grade 3 in group 1 while in group 2 there were 10 cases 50% with grade 2 epiphora and 10 cases 50% with grade 3 .2.here is statistically significant improvement of epiphora during follow up starting from the first day post-operative; group 1 changed to 50% no epiphora after 1 day ,70% no epiphora after 1 week and 1 month ,60% no epiphora at 3 month and 6 months, while group 2, better improvement is detected. there was 70% no epiphora after 1day, 80% after 1 week, 70% after 1 month , 80 % after 3 month and 90% after 6 month . 3.The incidence of patient satisfaction (resolution of symptoms and clearance of dye in FDDT) was higher in the Silicone Intubation group, but it didn’t reach a statistically significant value.4.Recurrence of epiphora was reported in 2 cases (10%) in group 1 due to re-stenosis of the punctum after 3months of punctoplasty while only one case (5%) in group 2 suffered from recurrence of epiphora due to re-stenosis after 5 months of silicone intubation.5.Only two cases in group 2 suffered from Tube extrusion after 3months of silicone intubation.6.In Conclusion Both three- snip punctoplasty and silicone intubation are safe and effective in treatment of punctal stenosis but,silicone intubation is less invasive , better tolerated and has more better results compared with three-snip punctoplasty. 7.Further Studies should be conducted with larger sample size from more than a single center 8.Early diagnosis and management of cases with epiphora for detection of the exact cause and provide correct management 9.Performing further studies to compare the two tested techniques in the current study with other operative techniques