A modified method for punctoplasty: “Excisional punctoplasty with the guidance of a 27 G Rycroft cannula”



Punctal stenosis, Punctoplasty, Surgical technique, Surgical revision, Epiphora


Aim: We modified conventional 2-snip punctoplasty to ease procedure and to perform with simple equipment which is widely accessible in the operation rooms. 

Methods: This new procedure has been performed to 10 eyes of 6 patients. After the appropriate width has been provided, a 27G anterior chamber cannula which is actually manufactured for cataract surgery was inserted to punctum and pushed forward 2 mm vertically and 1 mm horizontally. After that, the surgeon exposed the tip of cannulas by opening conjunctiva with conjunctival scissors (Westcott Conjunctival Scissors) from the projection site of the tip of the cannula. The Rycroft cannula is used for better guidance for canaliculus anatomy instead of lacrimal cannulas. After canaliculus was hanged with the cannula, a conjunctival incision was made from the entrance of cannula to the punctum towards the point where the cannula exposed from conjunctiva via Westcott scissors. In the next step, two sides of the formed flap were held with toothed forceps orderly and were removed by cutting with conjunctival scissors. 

Results: After 6 month follow-up, none of the patients complained with epiphora and satisfied with the surgery. All participants have been defined with the presence of Grade 3-5 punctal aperture with the references of Punctum Size Grading by Slit-Lamp Examination. 

Conclusion: In this article, we could apply this method to a very limited number of patients and our follow-up (6 months) is relatively short to claim the re-stenosis ratio but in the immediate postoperative period, we didn’t encounter any re-stenosis.


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Ulusoy MO, Atakan M, Kıvanç SA. Prevalence and associated factors of external punctal stenosis among elderly patients in Turkey. Arq Bras Oftalmol. 2017 Sep-Oct;80(5):296-99. doi: 10.5935/0004-2749.20170072.

Soiberman U, Kakizaki H, Selva D, Leibovitch I. Punctal stenosis: definition, diagnosis, and treatment. Clin Ophthalmol. 2012;6:1011. doi: 10.2147/opth.S31904.

Kashkouli MB, Beigi B, Murthy R, Astbury N. Acquired external punctal stenosis: etiology and associated findings. Am J Ophthalmol. 2003;136.6:1079-84. doi: 10.1016/S0002-9394(03)00664-0

Tabbara KF, Bobb AA. Lacrimal system complications in trachoma. Ophthalmology. 1980;198787(4); 298-301.

Jager GV, Bijsterveld OPV. Canalicular stenosis in the course of primary herpes simplex infection. Br J Ophthalmol. 1997;81(4):332.

Bowman W. Methode de traitement applicable a l'epiphora dependent du renversement en dehors ou de l'obliteration des points lacrymaux. Ann Oculist. 1853;29:52–5.

Graves B. Making a new lacrimal punctum. Am J Ophthalmol. 1926;9:675–7.

Thomas JBT. A modification of Graves' operation for epiphora due to stenosis of the lacrimal punctum. Br J Ophthalmol. 1951;35:306.

Viers ER. Disorders of the canaliculus in the lacrimal system, New York: Grune and Stratton.1955);46-7.

Jones LT. The cure of epiphora due to canalicular disorders, trauma and surgical failures on the lacrimal passages. Trans Am Acad Ophthalmol Otolaryngol. 1962;66:506–24.

Caesar R, McNab A. A brief history of punctoplasty: the 3-snip revisited. Eye (Lond). 2005;19(1):16. doi:10.1038/sj.eye.6701415

Chak M, Irvine F. Rectangular 3-snip punctoplasty outcomes: preservation of the lacrimal pump in punctoplasty surgery. Ophthalmic Plast Reconstr Surg. 2009;25(2):134-5. doi: 10.1097/IOP.0b013e3181994062.

Munk PL, Lin DT, Morris DC. Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology. 1990;177(3):687–90.

Dolin SL, Hecht SD. The punctum pucker procedure for stenosis of the lacrimal punctum. Arch Ophthalmol. 1986;104(7):1086-7.

Lam S, Tessler H. Mitomycin as adjunct therapy in correcting iatrogenic punctal stenosis. Ophthalmic Surg. 1993;24(2):123-4.

Cowen D. Stenotic puncta: microsurgical punctoplasty. Ophthalmic Plast Reconstr Surg. 1993;9(3):201-5.

Shahid H, Sandhu A, Keenan T, Pearson A. Factors affecting outcome of punctoplasty surgery: a review of 205 cases. Br J Ophthalmol. 2008;92(12):1689-92. doi: 10.1136/bjo.2008.140681.






Research Article

How to Cite

Temizsoylu O, Şahin G, Koçkar A, Şengül A, Yüzbaşıoğlu E. A modified method for punctoplasty: “Excisional punctoplasty with the guidance of a 27 G Rycroft cannula”. J Surg Med [Internet]. 2019 Mar. 15 [cited 2024 Jun. 19];3(3):258-61. Available from: https://jsurgmed.com/article/view/537361