Management of acquired punctal stenosis in trachomatous patients using single versus double silicone tube insertion (a pilot study)

Objective
This study compares the effect of double versus single bicanalicular silicone tube in reducing tear meniscus and degree of tolerance to their presence in patients with punctal stenosis.
Materials and methods
The interventional case series included 30 eyes of 15 patients with acquired epiphora with bilateral visible stenotic puncti defined by inability to insert a 26-G cannula into the punctum without dilation. Under general anaesthesia, punctal dilation and bicanalicular silicone intubation were performed: one on the right side and two on the left side. Tear meniscus height was evaluated using a slit-lamp scoring system (Z-IV) at 1 week, 1 month, 6 months (when tubes were removed) and 12 months. Patients' satisfaction was evaluated by another scoring system (from 1 to 5) in addition to punctal shape and complications.
Results
All patients had trachoma associated with punctal stenosis. Tear meniscus was reduced compared with the preoperative status at every follow-up in both groups, especially at 1 and 6 months in favour of the double intubation group ( < 0.05). No difference was found following tube removal. High patient satisfaction and tolerance were reported while tubes were in place in both groups, with minimal complications.
Conclusion
Double bicanalicular silicone intubation is as well tolerated as single tubes and could be considered in the management of acquired punctal stenosis, especially in patients with trachoma, mostly because of punctum overstretch with more potential space for tear drainage. Further studies are required to evaluate retaining of the stent to prevent recurrence following tube removal.