Anterior Segment OCT-Based Assessment of Efficacy of Topical Cyclosporine in Edematous Punctal Stenosis

Purpose To evaluate the effect of topical cyclosporine-A treatment on edematous punctal stenosis (PS) using anterior segment optical coherence tomography (AS-OCT). Methods Patients with edematous PS who suffered from epiphora for at least 3 months were prospectively evaluated. Those with history of acute/subacute infection, use of preservative-containing eyedrops or anti-glaucoma drops within 1 month, pathologies of other parts of nasolacrimal drainage system were excluded. All cases were treated with a regimen of two-week course of steroid drops and long-term preservative free cyclosporine-A drops. Munk score, outer punctal diameter (OPD), vertical canalicular length (VCL), inner punctal diameter (IPD) at 100 and 500µ, tear well diameter (TWD), tear well depth (TWDp) and punctal reserve (PR) on punctum-OCT were measured. Evaluations were performed at baseline, 1 month and 3 months post-treatment. Results Forty-four eyes of 22 patients were evaluated. Mean duration of symptoms was 7.4 ± 6.5 (3–24) months. Median Munk score was 4 (range 2–5) at the baseline, 0 (range, 0–5) at 1 month, and 1 (range, 0–3) at 3 months. Mean OPD at the 3rd month was significantly higher than the baseline (430.0 ± 115.5µ vs 491.4 ± 110.0µ, ANOVA p = 0.021). Other AS-OCT parameters did not show any significant change. One patient with no improvement in symptoms and findings with clinical treatment and underwent perforated punctal plug insertion. Conclusion Anti-inflammatory effect of topical Cyclosporine-A may be effective in managing long-lasting edematous PS by increasing the diameter of punctal opening and decreasing hyperlacrimation.