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2-snip puntoplasty with stent placement

This is Richard Allen at the University of Iowa. This video demonstrates a 2-snip punctoplasty with placement of Crawford stents. The patient has a history of punctal stenosis. A punctual dilator is introduced into the lower punctum vertically and then turned horizontally. A # 1 bowman probe is then introduced in the same fashion and a hard stop is appreciated, noting no canalicular obstruction. The same is performed on the upper lid. Again, the Bowman probe is first introduced vertically followed by horizontal advancement through the canaliculus where a hard stop is appreciated. The probe is then placed down the nasolacrimal duct. A Crawford stent is then introduced in the same manner as the Bowman probe. The stent is then rotated down the nasolacrimal duct. The stent is then retrieved from under the inferior turbinate with a Crawford hook. The same procedure is then performed on the lower lid. A hard stop is appreciated followed by rotation of the probe and advancement down the nasolacrimal duct. The stent is then retrieved from the nose. The punctoplasty is then performed. This is a 2-snip punctoplasty. A vertical snip is performed with Westcott scissors followed by a diagonal snip to remove the posterior portion of the vertical portion of the canaliculus. This performed only on the lower eyelid. The upper punctum remains intact to prevent postoperative cheese wiring by the stent. As you can see, this procedure enlarges the punctum. Over 300 oculoplastic surgery videos are available, free of charge, here on YouTube and at http://www.oculosurg.com