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Abstract ID: 24-118
Puncto-canalicular reconstruction after previous punctoplasty
Andre Litwin
Purpose
Punctoplasty has been used for over 90 years to widen a stenosed punctum in order to improve epiphora. Modern techniques take the preservation of the normal physiological lacrimal pump mechanism into consideration and avoid enlarging the punctum excessively. We describe a surgical technique to repair a slit punctum after previous punctoplasty. We describe a novel technique to return a slit punctum to one of normal size and calibre.
Methods
The technique of puncto-canalicular repair consists of de-epithelialization of the current peri-punctal area, followed by reconstruction with a conjunctival flap and placement of a monocanalicular stent.
Results
After one week, the mini-Monoka stent is removed. The conjunctival flap is visible and somewhat bulky (edematous) at this time, but after a further few weeks, the well-healed punctum has a much more normal appearance. This appearance is maintained at one year and the only indication of previous conjunctival surgery is a faint white scar of the conjunctiva. Patient symptoms improved over this time but did not complete resolve.
Conclusion
The reported technique may prove useful to oculoplastic surgeon’s in selected cases, as it can aid the restoration of the punctum’s capillary function.
Additional Authors
Javier Martínez Martín – Queen Victoria Hospital, East Grinstead
Katja Ullrich – Queen Victoria Hospital, East Grinstead