Punctal Stenosis
Narrowed tear-drainage openings of the eyelid
Quick Facts
- Type: Tear-drainage disorder
- Main symptom: Watery, overflowing eyes
- Location: Puncta at the inner eyelid margin
- Common in: Older adults
Overview
Tears keep the eye moist and then drain away through two tiny openings, called puncta, at the inner corner of the upper and lower eyelids. From there tears flow through small canals into a sac and down into the nose. Punctal stenosis is a narrowing or partial closing of these openings, so tears cannot drain properly and instead overflow onto the cheek.
The result is a persistently watery eye, which can be a nuisance and sometimes leads to skin irritation around the eye or recurrent eye infections. Punctal stenosis is more common with age and can usually be improved with simple in-office procedures once it is diagnosed.
Symptoms
The hallmark symptom is excessive tearing, since tears cannot leave the eye through the narrowed opening.
- Watery eyes with tears overflowing onto the cheek (epiphora)
- Blurred vision from a film of tears
- Irritation or chafing of the skin at the inner corner or lower eyelid
- Sticky discharge or recurrent low-grade eye infections
- A feeling that the eye is constantly wet, often worse in wind or cold
Symptoms may affect one or both eyes and tend to be ongoing rather than coming and going quickly.
Causes
Punctal stenosis develops when the tear-drainage opening becomes scarred, inflamed, or simply narrowed over time. Causes include:
- Aging: The most common reason, as the puncta naturally narrow with age
- Chronic inflammation: Long-standing blepharitis (eyelid inflammation) or conjunctivitis
- Infections: Certain viral or other eye infections that scar the opening
- Medications: Some eye drops and certain chemotherapy drugs
- Trauma or prior surgery involving the eyelid or tear-drainage system
Sometimes no clear cause is found.
Risk Factors
- Older age
- Chronic eyelid inflammation (blepharitis)
- Recurrent eye infections
- Long-term use of certain eye drops or chemotherapy
- Previous eyelid injury or surgery
Diagnosis
An eye specialist can usually diagnose punctal stenosis during an examination:
- Slit-lamp examination: Magnified viewing shows whether the punctal openings are narrowed or closed.
- Dye disappearance test: A drop of dye placed in the eye should drain away within a few minutes; delayed clearance suggests a drainage problem.
- Probing and irrigation: Gently flushing the tear-drainage system locates and confirms where the narrowing is.
These tests also help separate punctal stenosis from blockages deeper in the tear-drainage pathway.
Treatment
Treatment aims to open or widen the punctum so tears can drain again. The approach depends on how narrow the opening is.
- Treating inflammation: Managing blepharitis or other eye irritation may reduce mild narrowing.
- Punctal dilation: A clinician gently widens the opening with a small instrument, sometimes enough on its own.
- Snip procedure (punctoplasty): A minor in-office procedure enlarges the opening and is often effective for ongoing tearing.
- Stenting: A tiny tube may be placed temporarily to keep the passage open while it heals.
Most people see good improvement in tearing after a minor procedure, and serious complications are uncommon.
Prevention
Punctal stenosis cannot always be prevented, especially when it results from aging. However, treating chronic eyelid inflammation and recurrent eye infections promptly, practicing good eyelid hygiene, and reviewing long-term eye drops with your doctor can reduce the irritation and scarring that contribute to narrowing of the tear-drainage openings.
When to See a Doctor
See an eye doctor if you have constantly watery eyes that overflow onto your cheek, blurred vision from tears, or recurrent eye irritation and discharge. Seek prompt care if the inner corner of the eyelid becomes red, swollen, and painful, which can mean an infection of the tear sac that needs treatment.
Frequently Asked Questions
What causes watery eyes in punctal stenosis?
The puncta, the tiny openings that drain tears from the eye, become narrowed, so tears cannot flow away and instead overflow onto the cheek. This is why the main symptom is constant watering rather than dryness.
Can punctal stenosis be fixed?
Yes. Mild cases may improve by treating eyelid inflammation, and the opening can often be widened with a quick dilation. A minor in-office procedure called punctoplasty enlarges the opening and relieves tearing in most people.
Is punctal stenosis serious?
It is usually not dangerous, but the constant tearing is bothersome and can cause skin irritation or recurrent infections. Because blocked drainage can sometimes lead to a tear-sac infection, persistent symptoms should be evaluated.
Why do older adults get punctal stenosis?
The tear-drainage openings naturally tend to narrow with age. Long-standing eyelid inflammation and certain eye drops can add to this, which is why watery eyes from punctal stenosis are more common in later life.
References
- American Academy of Ophthalmology. Punctal Stenosis.
- Mayo Clinic. Blocked tear duct.
- MedlinePlus, U.S. National Library of Medicine. Tearing.
- StatPearls, National Library of Medicine. Punctal Stenosis.