The patient may present with tearing and evaluation for distal nasolacrimal duct obstruction should be performed as this may occur simultaneously.[1] Etiology Many factors have been linked to the development of punctal stenosis, including the following [eyewiki.aao.org]

People with NLDO commonly present with epiphora (watery eyes), which significantly impacts their quality of life (Shin 2015). [cochranelibrary.com]

• Surgical Procedure

  Two common antimetabolites used in ocular surgical procedures are mitomycin C (MMC) and 5‐fluorouracil (5‐FU). MMC is a toxic natural product of certain bacteria that causes the cross‐linking of DNA. [cochranelibrary.com]

• Lacrimation

  MATERIAL AND METHOD There were inserted perforated plugs into inferior lacrimal puncta to twelve patients with epiphora due to proximal stenosis in efferent lacrimal ducts. Their size were predeterminated by caliper measuring. [semanticscholar.org]

  The goals of surgery include creating an adequate opening, maintaining punctal position against the lacrimal lake, improving tear access from the lacrimal lake to the punctal opening, and preserving function of the lacrimal pump. [eyewiki.aao.org]

  NLDO is diagnosed by assessing the patency of the lacrimal drainage system with lacrimal irrigation. Typically, a tube, known as a cannula, is placed into the puncta and canaliculi and saline is irrigated. [cochranelibrary.com]

• Dry Eyes

  Kapitola Onemocnění víček a slzných cest Grada Publishing, 1997 Long - term followof punctal and proximal canalicular stenoses after silicone punctal plug treatment in dry eye patients Am J Ophthalmol 2008 Neprůchodnost odvodných slzných cest dětí a dospělých [semanticscholar.org]

  […] eyelid malposition, and signs of previous surgery Schirmer test can help quantify basal tear production, differentiating an obstructive cause from dry eye with reflex tearing. [eyewiki.aao.org]

}, year={2012}, volume={68 4}, pages={ 147-9 } } PURPOSE Retrospective evaluation of treatment of epiphora due to punctal stenosis with application of perforated plugs as well as evaluation of complications. [semanticscholar.org]

The wedge punctoplasty for treatment of punctal stenosis. Ophthalmic surgery. 1992;23(12):818-821. ↑ Awan KJ. Laser punctoplasty for the treatment of punctal stenosis. American journal of ophthalmology. 1985;100(2):341-342. [eyewiki.aao.org]

One study each compared treatment with EX‐DCR with different doses of MMC, You 2001, or treatment with EX‐DCR with different doses of MMC and 5‐FU, Yalaz 1999. [cochranelibrary.com]

Acquired external punctal stenosis: etiology and associated findings. American journal of ophthalmology. 2003;136(6):1079-1084. ↑ Mohebbi M, Mirghorbani M, Banafshe Afshan A, Towfighi M. [eyewiki.aao.org]

It is not known if the etiology of NLDO differs by race or socioeconomic status. NLDO may be partially due to anatomic changes in the diameter of the bony lacrimal canal (Janssen 2001), which occurs with aging. [cochranelibrary.com]

[…] tropicamide, naphazoline, artificial tears[8] Systemic medications: 5-fluorouracil, docetaxel,[9] paclitaxel, idoxuridine Systemic diseases: acrodermatitis enteropathica, porphyria cutanea tarda, Stevens-Johnson Syndrome,[10] graft-versus-host disease Pathophysiology [eyewiki.aao.org]

In DCR surgery, antimetabolites are applied intraoperatively to the surgical ostium to prevent postoperative closure of the opening. The concentration and length of application of the agents may vary. [cochranelibrary.com]