Canalicular Cut Down for Punctal Stenosis
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This is Richard Allen at the University of Iowa. This video demonstrates a canalicular cut down for treatment of punctal/canalicular obstruction. The patient has a history of epiphora secondary to upper and lower punctal stenosis. The upper punctum is identified and dilated with the punctal dilator. The lower has more significant punctal stenosis and the punctal dilator is unable to find the opening of the punctum. Multiple attempts are made including one attempt in which a possible opening is found, but this appears to be a false passage. A pigtail probe is then used to see if the punctum can be found in a retrograde fashion, but this too is unsuccessful. Therefore, a canalicular cut down will be performed. Westcott scissors are used to make an incision medial to where the punctum should be through the eyelid margin in order to see if a patent canaliculus can be identified. The canaliculus is able to be identified and a Bowman probe is placed and passed through the canaliculus where a hard stop is appreciated. The distal end of the canaliculus is identified and the punctal dilator is placed through the canaliculus in order to open the punctum which has a significant obstruction. A Crawford stent is then placed through the punctum and canaliculus. The proximal end of the canaliculus is dilated. The Crawford stent is then passed through the proximal cut end of the canaliculus where a hard stop is appreciated. The stent is then placed down the nasolacrimal duct and retrieved from the nose. The Crawford stent is then placed through the upper system followed by the nasolacrimal duct and retrieved from the nose. Inspection shows the stent to be in good position. The canaliculus is then repaired in the same fashion that a canalicular laceration would be repaired. 7-0 vicryl suture is placed in a pericanalicular fashion around the stent. Sutures are then placed to reapposed the skin. At the conclusion of the case, the stent is demonstrated to be in good position without significant tension. Antibiotic ointment is placed over the repair and the patient returns in one week for reevaluation.
