Punctoplasty

Anesthesia Implications

Position: Supine, arms tucked, Bed turned 90 degrees
Time: 30-60 min (short)
Blood Loss: Zero
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No

Approach – MAC. Typically 1-2mg versed given in preop. Nasal cannula is usually sufficient. The surgeon will apply a topical anesthetic to the eye and then inject local. 50-60mg propofol and 25-75mcg fentanyl before surgeon injects local anesthetic into eye.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

Punctoplasty is performed to treat punctal stenosis. The puncta are small openings on the inner corner of the upper and lower eyelids. They are drainage channels for tears to flow from the eyes into the tear drainage system.

Punctal stenosis involves the narrowing or complete blockage of one or both puncta. This can occur due to age, inflammation, trauma, infection, and systemic disease.

When the puncta becomes occluded, it results in inadequate tear drainage leading to excessive tearing. The accumulation of tears on the ocular surface can cause discomfort, blurred vision, etc.

An incision is made near the affected punctum to remove scar tissue or other obstructions that are causing the stenosis.

Then the surgeon will widen the punctal opening either with an incision or dilation techniques.

The surgeon will then close the incision with sutures or let it close on its own.