Punctoplasty restores the opening into the tear-drainage pathway when it is narrowed. Assessment first confirms whether the puncta cause the tearing and whether downstream passages are patent.
Patients with confirmed acquired punctal stenosis and symptomatic epiphora. Punctal malposition only after determining whether punctoplasty or eyelid correction is the primary treatment. If the lower eyelid is malpositioned, it is important to assess whether the punctum contacts the tear lake. Eyelid correction may be needed instead of simply widening the punctum.
Partial punctal atresia or cicatricial narrowing after inflammation, trauma or surgery when the opening is reconstructable.
Recurrent stenosis after temporary benefit from dilation when a more durable correction is indicated.
Combined punctocanalicular stenosis as part of a broader reconstruction when supported by anatomy.
Do not attempt to dilate the punctum yourself and do not use antibiotic or steroid eye drops without medical advice.
Indications are determined by an ophthalmic surgeon after evaluating the entire lacrimal drainage pathway. This list is not for self-diagnosis.
Elective punctoplasty is generally deferred during active infectious or inflammatory eyelid and conjunctival disease, uncontrolled ocular surface inflammation, acute systemic infection or decompensated medical illness. Coagulation disorders and antithrombotic medication require individualized assessment; medication should not be stopped without medical advice.
If tearing is caused by dry eye, ectropion, canaliculitis, dacryocystitis or a more distal obstruction, isolated punctoplasty may not resolve symptoms.
Tell the doctor whether one or both eyes tear and whether symptoms are constant or mainly triggered by wind, cold or outdoor exposure.
Bring previous irrigation, probing and lacrimal or eyelid surgery records if available.
Mention blepharitis , conjunctivitis, rosacea and dry- eye symptoms because ocular surface disease can affect the interpretation of tearing.
Painful swelling near the inner canthus, purulent discharge, fever or rapidly spreading redness requires urgent medical assessment. Urgent evaluation is needed for increasing pain and swelling at the inner canthus, purulent discharge, fever, redness spreading to the eyelids and face, reduced vision or marked photophobia.
Urgent evaluation is needed for increasing pain and swelling at the inner canthus, purulent discharge, fever, redness spreading to the eyelids and face, reduced vision or marked photophobia.
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The doctor reviews tearing, lid and ocular-surface conditions, injuries and previous procedures.
Lid position, punctal contact with the tear lake and opening size and shape are assessed.
Dilation, irrigation, probing and additional tests are used when indicated to exclude deeper obstruction.
The team determines whether punctoplasty is sufficient or eyelid correction, a stent or canalicular reconstruction is needed.
Anaesthesia is selected according to surgical extent, age and reconstruction plan.
The surgeon widens or creates the punctum using the selected technique, considering anatomy.
Combined disease may require stenting or canalicular treatment when indicated.
The doctor assesses healing, punctal position and changes in tearing; review timing is individualised.
Punctoplasty helps widen the narrowed opening through which tears enter the drainage system.
Restoring drainage can reduce persistent tear overflow when impaired tear drainage is the cause.
The doctor considers how the punctum contacts the eye so correction matches the mechanism of watering.
The correction method is selected after assessing tear pathways, eyelid position and, when necessary, the nasal cavity.
Book an ophthalmology or ophthalmic-surgery consultation at KazRIED so the punctum, eyelid position and lacrimal drainage pathway can be assessed before choosing punctoplasty or another treatment.
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A lacrimal punctum is a small opening near the inner edge of each upper and lower eyelid. Tears enter the vertical portion of the canaliculus through each punctum, then pass into the lacrimal sac and onward to the nasal cavity.
If the opening is narrowed, closed, or turned away from the ocular surface, tears may collect and overflow onto the cheek.
Persistent tearing does not automatically indicate punctal stenosis. Causes may include increased tear production from irritation or dry eye, blepharitis, ectropion, lacrimal pump dysfunction, canalicular obstruction, or nasolacrimal duct obstruction.
The cause and level of dysfunction must be identified before treatment. Even a well-performed punctoplasty will not resolve symptoms primarily caused by the ocular surface, eyelid position, or another part of the drainage pathway.
For true punctal stenosis, the surgeon aims to create an opening sufficient for drainage while preserving lacrimal pump function. Excessive enlargement is not the goal.
A major 2024 review notes that there is no universal gold standard. Alongside traditional incisional snip techniques, nonincisional and tissue-preserving approaches are used.
The method is selected according to the anatomy of the punctum and adjacent canaliculus.
Punctoplasty and canalicular reconstruction are different procedures. If narrowing extends deeper or the canaliculus is scarred, reconstruction and temporary silicone intubation may be needed.
When the punctum is everted because of ectropion, enlarging the opening alone may not help because it does not contact the tear lake. Treatment instead addresses eyelid and punctal position.
Slit-lamp examination may be used during assessment. The clinician determines whether it is needed.
The source list includes separate items for reconstruction of one lacrimal canaliculus:
These are deeper reconstructive procedures and should not be equated with punctoplasty.
Before booking, confirm the exact operation name and code, what the service includes, and its cost. The price of a neighboring service does not establish the cost of the prescribed procedure.
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
