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A punctoplasty, more commonly known as watery eye surgery, is an ophthalmic surgical procedure performed to correct punctal stenosis (a condition that causes tears to overflow from the eyes) by widening the punctal opening to allow the tears to drain with ease.
Watery eye is caused by either the excess production of tears or when the eye’s drainage system is too narrow or is blocked.
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A punctoplasty is beneficial for all patients who suffer from watery eye, a condition wherein a person’s tears overflow from the eyes, a symptom known as epiphora. Thus, it is helpful for those who have a condition called punctal stenosis, wherein the puncta, or the little holes in the eyelids that allow tears to drain, are too narrow or are blocked. This condition, which is more common among the elderly, is sometimes caused by the chronic inflammation of the eyelids (blepharitis) and the use of topical antihypertensive medications.
A punctoplasty is also helpful for patients whose lacrimal glands produce too much tears, which can be caused by several factors, such as eye irritation or dryness that causes the glands to compensate by producing more tears than normal. This is why some patients who suffer from watery eyes are treated using artificial tears. By first resolving the dryness of the eyes, the excess tear production is also prevented.
Records show that watery eye surgery has a high success rating of 86% to 96%.
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A punctoplasty or watery eye surgery is a simple ophthalmic procedure that takes just 10 to 30 minutes. It is done on an outpatient basis and requires only local anaesthesia, which is usually administered in the form of ophthalmic drop. Patients can undergo the procedure while lying down on an operating table or sitting in an exam chair.
Prior to the procedure and after the anaesthesia has been administered, the surgeon injects epinephrine subcutaneously and uses a punctal dilator to dilate the punctum. The surgical site is also prepped by grasping the punctal wall with forceps and opening up the area where the incisions are to be made.
Ophthalmologic surgeons use different methods to perform a punctoplasty. It is possible to widen the punctal opening using a special instrument called a Kelly punch. Another alternative is to temporarily use a perforated punctal plug, a small plug with a hole for drainage that can be left in place for up to 6 weeks to enlarge the punctum, allowing tears to drain in a more efficient manner.
However, the most common technique used is cutting out a small piece of the punctum. This can be done using four different approaches, namely:
- One-snip punctoplasty, which involves making a single vertical incision through the punctal wall
- Two-snip punctoplasty, which involves making vertical incision through the punctal wall followed by a horizontal incision along the canaliculus
- Triangular three-snip punctoplasty – In this procedure, the surgeon makes a vertical incision through the punctal wall, a horizontal incision along the canaliculus, and a diagonal incision to connect the first two incisions.
- Rectangular three-snip punctoplasty – This involves making two vertical incisions through the punctal wall and the vertical canaliculus, which are then connected by a horizontal incision.
These procedures all effectively enlarge the opening of the punctum, allowing tears to drain more easily.
After the procedure, patients are allowed to return to their normal activities, as long as they follow the surgeon’s post-procedural instructions.
المخاطر والمضاعفات المحتملة
A punctoplasty is associated with the following risks:
- Pain or discomfort – Patients may experience some discomfort especially due to the injection. The anaesthetic eye drops may also sting a bit. However, both do not affect a person’s vision after the surgery.
- Recurrence of punctal stenosis – The rate of recurrence is higher in 1-snip and 2-snip procedures because there is a tendency for the edges of the punctal and canaliculi incisions to heal together. This can be prevented by using punctal plugs.
- Trauma to the eye – This is a theoretical risk that exists in any kind of surgery performed near or around the eyes, but it rarely occurs.
- Temporary blurring of vision – This is a common side effect of the use of antibiotic ointments and will resolve once the medication period ends. However, it may keep patients from doing certain activities, such as driving, for some time after the ointment is administered.
If incisions were made, there is some risk of bruising usually at the inner part of the lower eyelid. This will resolve on its own after a few days. Scarring is not usually a concern as the surgery does not leave any visible marks.
To help minimise the risks of a watery eye surgery, ophthalmologists prescribe antibiotic and anti-inflammatory ointments or eye drops such as erythromycin, which the patients are instructed to use 3 times a day, usually for 5 days following the procedure. These help facilitate proper healing of the surgical site. Before administering the medications, patients are instructed to wash their hands. They are also taught how to properly clean the eye regularly, and are advised to refrain from touching or rubbing the eye.
Patients are also advised to keep their follow-up visit, which is usually scheduled a few days after the surgery was performed to check for signs of infection and ensure that the procedure successfully resolved the problem.
Ophthalmologists also usually schedule another follow-up check several months after the surgery to check for signs of recurrence.
- Hurwitz JJ. The lacrimal drainage system. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. St. Louis, Mo: Mosby Elsevier; 2013:chap 12.15.
What is Punctoplasty? Overview, Benefits, and Expected Results
What is Punctoplasty?
Punctoplasty is a medical procedure that involves the repair and reconstruction of the tear drainage channels of the eye. The condition is also known as punctal stenosis or ectropion. In this procedure, the punctal opening and mucosal surface of the eye is repaired or reconstructed to restore the natural drainage of the eyes.
Punctal stenosis is a condition in which the punctal opening in the eyelids is blocked or narrowed, obstructing the drainage of tears and causing dry eyes. This condition can cause discomfort, redness, pain, and a feeling of the eyes being scratchy or gritty. It can also affect your eyesight and may cause inflammation or infection of the cornea, leading to permanent vision loss.
What Does Punctoplasty Involve?
Punctoplasty is performed as an outpatient procedure. Typically, a local anesthetic will be used to numb the area. The tear ducts are then opened, and a small tube or probe is inserted to clear any blockages. The surgeon may then use an instrument called a cannula to scrape away any scar tissue that may be present. Once the procedure is complete, the incision is closed and the eye is lightly bandaged.
Benefits of Punctoplasty
Punctoplasty offers a number of benefits, including:
- Relieves symptoms of dry eye syndrome, such as redness, burning, and tearing
- Reduces the risk of permanent vision loss due to corneal infection
- Improves vision and comfort
- Reduces the risk of tear-related complications, such as infection, inflammation, or corneal scarring
- Reduces the need for artificial tears
- Improves the natural drainage of tears from the eyes
Expected Results from Punctoplasty
Most people can expect to see an improvement in their dry eye symptoms shortly after the procedure. With proper care, the results of punctoplasty can last for years.
Risks and Complications of Punctoplasty
Although punctoplasty is generally safe and effective, there are some risks associated with the procedure. Common complications include:
- Pain or discomfort
- Scarring of the eye
- Swelling of the eye
- Bleeding or bruising
- Allergy or reaction to the anesthesia
- Temporary or permanent vision loss
It’s important to note that all surgeries carry risks, and it is important to discuss these risks with your doctor before undergoing the procedure.
Preparing for Punctoplasty
Before the procedure, it’s important to have a full consultation with your doctor. They will assess your individual needs and discuss any risks or potential complications of the procedure.
Your doctor may also advise you to stop taking any medications that may increase the risk of bleeding, such as aspirin or warfarin. You may also be asked to stop wearing contact lenses for a few days before the procedure.
Recovering from Punctoplasty
Recovery from punctoplasty is typically quick and easy. After the procedure, you may experience some discomfort, swelling, and bruising around the eye. However, these should start to resolve within a few days and can be managed with over-the-counter pain medications.
Your doctor will provide you with eye drops and may recommend the use of cold compresses to reduce swelling. You should also avoid rubbing or putting any pressure on the eye for at least a week after the procedure.
Punctoplasty is a safe and effective procedure for treating dry eyes and restoring the natural drainage of tears from the eyes. Most people can expect to see an improvement in their symptoms shortly after the procedure, and the results can last for years. It’s important to have a full consultation with your doctor before undergoing the procedure to ensure that it is the right treatment for you.