3-Snip Punctoplasty with Silicone Tube Implantation: A Simple Procedure For Punctal Disorders
DOI:
https://doi.org/10.35749/oi.v52i1.101872Keywords:
3-Snip Procedure, Punctoplasty, Punctal Disorder, Punctal Atresia, CanaliculitisAbstract
Introduction: Punctal or canalicular atresia is a rare disorder in which an intact epithelial layer covers the punctum, impairing tear drainage and causing epiphora, especially in lower punctal atresia. Less frequently, canalicular atresia occurs. Standard management involves probing, irrigation, and silicone tube insertion. Case Report: In two cases, an 8-year-old and a 30-year-old female presented with lifelong tearing and discharge from the left eye. Ophthalmic examination revealed imperforate superior and inferior lacrimal puncta, and the Dye Disappearance Test (DDT) confirmed reduced tear drainage, leading to a diagnosis of punctal atresia. In a third case, a 40-year-old female experienced a painful, red lump on the right medial lower eyelid over a three-month period. Palpation produced yellowish discharge, and examination revealed a hyperemic mass with granulomas around the punctum, consistent with chronic canaliculitis. All three patients underwent a 3-snip punctoplasty with silicone tube implantation using a round-tip pigtail probe. Discussion: The 3-snip procedure is a minimally invasive and effective treatment for punctal disorders. It involves one basal cut and two vertical incisions along the canaliculus. Although canaliculotomy with curettage can lead to fistula formation, the use of a silicone tube helps prevent this complication. At the three-month follow-up, all patients demonstrated functional tear drainage and normal DDT results. Conclusion: The 3-snip procedure with silicone tube implantation offers favorable functional and cosmetic outcomes. It is a simple and viable option for ophthalmologists in resource-limited settings, ensuring improvement in tear drainage without symptom recurrence.
Downloads
References
Caesar RH, McNab AA. A brief history of punctoplasty: the 3-snip revisited. Eye (Lond). 2005;19(1):16–18.
S. Kaliki, M. J. Ali, S. G. Honavar, G. Chandrasekhar, and M. N. Naik, “Primary canaliculitis: clinical features, microbiological profile, and management outcome,” Ophthalmic Plastic and Reconstructive Surgery, vol. 28, no. 5, pp. 355–360, 2012.
Singh S, Ali MJ, Mohamed A. Comparison of outcomes of 3-snip punctoplasty versus simple punctal dilatation with monocanalicular intubation for acquired punctal stenosis. Ophthalmic Plast Reconstr Surg 2018;34:375-7.
Chak M, Irvine F. Rectangular 3-snip punctoplasty outcomes: Preservation of lacrimal pump in punctoplasty surgery. Ophthalmic Plastic and Reconstructive Surgery. 2009; 25: 134–135.
Ali MJ, Ayyar A, Naik MN. Outcomes of rectangular 3-snip punctoplasty in acquired punctal stenosis: is there a need to be minimally invasive eye. 2015;29:515-8.
Murdock, Jennifer; Lee, Wendy W.; Zatezalo, Chad C.; Ballin, Annelyse (2015). Three-Snip Punctoplasty Outcome Rates and Follow-Up Treatments. Orbit, 34(3), 160 163. doi:10.3109/01676830.2015.1014513.
Singh S, Ali MJ, Mohammed A. Comparison of Outcomes of 3-Snip Punctoplasty Versus Simple Punctal Dilatation With Monocanalicular Intubation for Acquired Punctal Stenosis. The American Society of Ophthalmic Plastic and Reconstructive Surgery. Vol 34. No 4, 2018.
Tamer SS, Abdelghany AA, Elshafei AMK. Three-snip punctoplasty versus perforated plugs for management of lacrimal punctal stenosis. European Journal of Ophthalmology. 2020.
Hussain RN, Kanani H, McMullan T. Use of mini-monoka stents for punctal/canalicular stenosis. British Journal of Ophthalmology. 2012;96(5):671-673.
Khedr AM, Maali AA, Tawfik A, Kotb AN. Efficay of Minimonoka stents versus bicanalicular annular stents for Treatment of Lacrimal Canalicular Stenosis. Journal of Cardiovascular Disease Research. Vol 12. Issue 04. 2021.
Freedman, J.R.; Markert, M.S.; Cohen, A.J. Primary and secondary lacrimal canaliculitis: A review of literature. Surv. Ophthalmol. 2011, 56, 336–347
Alam SM, Poonam SN, Mukherjee B. Outcomes of canaliculotomy in recalcitrant canaliculitis. Saudi Journal of Ophtalmology (2019) 33, 46-41.
Anand S, Hollingworth K, Kumar V, et al. Canaliculitis: the incidence of long-term epiphora following canaliculotomy. Orbit 2004;23:19–26.
Kim HM, Ra H. A case report on complete cure of recurrent primary canaliculitis by 4-snip punctoplasty and canalicular curettage. Medicine 2018; 97:49.
Wang, M.; Cong, R.; Yu, B. Outcomes of Canaliculotomy with and without Silicone Tube Intubation in Management of Primary Canaliculitis. Curr. Eye Res. 2021, 46, 1812–1815
Lin, S.-C.; Kao, S.-C.; Tsai, C.-C.; Cheng, C.-Y.; Kau, H.-C.; Hsu, W.-M.; Lee, S.-M. Clinical characteristics and factors associated the outcome of lacrimal canaliculitis. Acta Ophthalmol. 2011, 89, 759–763.
Mohan ER, Kabra S, Udhay P, Madhavan HN. Intracanalicular antibiotics may obviate the need for surgical management of chronic suppurative canaliculitis. Indian J Ophthalmol. 2008;56(4):338.
Downloads
Published
Issue
Section
Categories
License
Copyright (c) 2026 Aisyah Amelia Zulkarnaen R Wattimena, Andi Pratiwi, Halimah Pagarra, Suliati P Amir, Syukriah Sofyan
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.