Investigators evaluated the use of bicanalicular silicone intubation for managing punctal stenosis and obstruction in patients with allergic conjunctivitis.

Study design: The study comprised 98 eyes (51 patients); 85 eyes underwent placement using a pigtail probe and 13 eyes had a Crawford tube placed into the nose. Prior to surgery, all patients had severe epiphora (Munk grade 4 or worse) and Kashkouli grade 1 or 2 punctal stenosis. A topical steroid/antibiotic was used for 2 weeks, and a topical antihistamine/mast cell stabilizer was used for at least 3 months.

Outcomes: At least 6 months after tube removal, 86 eyes (88%) showed improved Munk epiphora scores to grade 2 or better. Approximately 92% of patients demonstrated anatomical improvement to a normal-sized grade 3 punctum. Early tube prolapse occurred in four patients, and two of those patients reported no improvement in tearing.

Limitations: It is possible that the topical medical regimen improved the conjunctivitis and the associated punctal stenosis in some patients. Silicone tube placement is somewhat invasive, and it is possible that simply placing a plug or performing multiple dilations could have achieved a similar effect.

Clinical significance: Bicanalicular silicone intubation appears to mechanically stretch the punctae, resulting in long-term improvement for cases of punctal stenosis associated with allergic conjunctivitis.