This work aimed to assess the efficacy and safety of autologous PRP versus AS in treatment of moderate to severe DED. A prospective, comparative, randomized controlled clinical trial involved 96 eyes of 48 cases with moderate and severe DED divided into 3 groups (16 patients each). Group 1 received PRP eye drops, Group 2 received AS eye drops and Group 3 (control group) received sodium hyaluronate eye drops. All participants were subjected to Ocular Surface Disease Index (OSDI), tear film break-up time (TBUT), Schirmer 1 test, ocular surface staining, and best corrected visual acuity (BCVA). PRP and AS showed significant improvements in all parameters compared to sodium hyaluronate, with greater improvement in OSDI, Schirmer test and ocular surface staining with PRP compared to AS. PRP and AS have high safety and efficacy rates in moderate and severe DED, providing better symptom relief and clinical improvements than artificial tears with superiority for PRP over AS.

Purpose: To investigate the agreement between the Goldmann tonometer (GAT), the air-puff tonometer, and the iCare tonometer in intraocular pressure (IOP) evaluation as well as their association with central corneal thickness (CCT) in normal participants, glaucoma patients, and patients following refractive surgery. Methods: This is a cross-sectional study conducted on 204 eyes from 102 patients. The study consisted of three equal groups: group I (control group, n = 34), group II (glaucoma patients on medication, n = 34), and group III (refractive surgery patients, n = 34). All patients were subjected to examination (complete ocular examination, refraction, and IOP measurement). Results: A total of 102 participants were included in the study with both genders distributed equally. The mean ± standard deviation age was 44.12 ± 12.8 years in the control group while it was 46.29 ± 13.24 years in the glaucoma group and 40.68 ± 15.86 years in the refractive surgery group. Overall, there was a high correlation between the three methods. The mean IOP measured by GAT was 14.03 ± 3.43. The mean IOP measured by iCare was 15.16 ± 3.46. The mean IOP measured by air-puff was 16.66 ± 3.6. The iCare showed the most significant agreement with the GAT (intraclass correlation coefficient [ICC] 0.985, P > 0.05) and the mean difference in IOP between GAT and iCare was 1.1 (95% limits of agreement, −0.62–+2.85 mmHg). The mean difference in IOP between iCare and air-puff was 1.5 and it was 2.6 between GAT and air-puff. There were no significant differences in IOP measurements between GAT and iCare tonometer or between iCare tonometer and air-puff in all groups (P > 0.05). However, there were significant differences in IOP measurements between GAT and air-puff in all groups (P < 0.001). The ICC between all studied methods was strong (ICC > 0.92 for all). Regarding CCT, the mean CCT was 517.14 ± 29.82 μm. There were significant positive correlations between increasing CCT and increasing IOP by GAT, iCare, and air-puff tonometer among the three groups (P < 0.001). Conclusions: In conclusion, the iCare tonometer, specifically the iCare PRO RT model, is a reliable and efficient alternative instrument for assessing IOP. The IOP values obtained with the iCare PRO RT were found to be consistent with those obtained using the air-puff and GAT.

Background Optical coherence tomography angiography (OCTA) is a sophisticated ophthalmic imaging technique, enables us to obtain images of blood vessels and blood flow at different levels of the retina and choroid without the use of contrast. Therefore, its potential application could be useful in the early detection of retinal vascular and macular pathologies and to recognize the pathogenesis of various ophthalmic diseases. Aim In this study, OCTA was utilized to detect the macular changes in eyes with high myopia. Patients and methods This cross-sectional study was carried out at the Department of Ophthalmology of Menoufia University Hospital according to the Helsinki Declaration and the Code of Ethics for Human Research of the World Medical Association and after obtaining approval of the institutional review board (IRB) 10/2022 OPHT 32. A total of 152 eyes of the study participants were included in this study and were divided into group A, which includes 76 eyes of highly myopic participants (>−6 D), and group B includes 76 eyes of nonmyopic (emmetropic) participants. Result In our study, there was a high statistically significant difference between the studied groups as regards axial length. In group A, it was 27.26±0.74 mm, while in group B, it was 23.14±0.73 mm ( P <0.001). Regarding the comparison between studied cases according to the superficial and deep vascular density (SVD and DVD), there was a statistically significant difference between the studied groups. As regards overall SVD in group A, it was 46.48±4.78 while in group B, it was 51.78±2.8 ( P <0.001). Meanwhile, the overall DVD in group A was 56.67±3.98, while in group B was 58.76±2.27 ( P <0.001). Conclusion In the light of our study, OCTA shows significantly reduced SVD and DVD in eyes with high axial myopia, which could be an important aspect of understanding the natural history and etiology of pathologic myopia.

To compare the different methods of clinical evaluation of upper eyelid congenital blepharoptosis and discuss the utility of margin-reflex distance (MRD1) over levator muscle function (LF) in choosing the appropriate surgical procedure for congenital blepharoptosis correction.

Objective The aim was to assess the impact of ostium size on endoscopic dacryocystorhinostomy success and determine the ideal ostium size that can provide a sufficient postoperative ostium patency. Materials and Methods Four databases were searched in this study, including Scopus, PubMed, Google Scholar, and Web of Science from January 2000 to December 2020. Studies assessed anatomical success by measuring ostium dimensions and functional success by irrigation and dye-disappearance test after endoscopic dacryocystorhinostomy for patients with nasolacrimal duct obstruction. If the studies did not meet inclusion criteria, they were excluded, for example, external dacryocystorhinostomy or assessment without measuring ostium dimensions through follow-up. Study-quality assessment included whether ethical approval was gained, eligibility criteria specified, adequate information, and defined assessment measures. Comparisons were made by structured review with the results tabulated. Findings In total, 10 potentially relevant publications were included, an ostium measuring greater than or equal to 8 × 5 mm should be a satisfactory large size. There is no significant shrinkage of the ostium after the fourth week of the operation. Conclusion Functional success should be considered when evaluating the overall success of dacryocystorhinostomy. An anatomically patent ostium is required, while it is believed that ostium size does not affect functional surgical success.

Objective The aim of this study was to demonstrate the occurrence of vitreoretinal interface changes in patients with macular edema secondary to branch retinal vein occlusion (BRVO) and diabetic macular edema (DME) after intravitreal injection (IVI) of aflibercept (anti-vascular endothelial growth factor). Background IVI of aflibercept is an effective treatment for macular edema (ME) secondary to BRVO and DME. Patients and methods This prospective comparative case series study was carried out on 50 eyes of 30 patients coming to the Ophthalmology Department of Menoufia University Hospitals. Patients included had ME secondary to BRVO and DME. Patients were randomly enrolled into two groups. Group A included 16 eyes which had ME secondary to BRVO. Group B included 34 eyes which had ME secondary to DME. Results The results revealed that there was no significant difference between the studied groups regarding postoperative visual outcome and central macular thickness. However, there was a significant increase in epiretinal membrane complication in BRVO group than DME group postoperatively. Conclusion After IVI of aflibercept for ME, there was a significant improvement in visual acuity, all over the period of follow-up. Moreover, the optical coherence tomography improved significantly. The rate of complications was higher in the BRVO group than the DM group. The presence of vitreoretinal interface abnormalities affected the effectiveness of anti-vascular endothelial growth factor and final visual outcome.

ObjectiveThe aim of the study was to investigate the correlation between the retinal layer metrics and visual acuity (VA) in diabetics with and without diabetic macular edema (DME).BackgroundDiabetes is known to cause alterations in retinal microvasculature that progressively lead to visual impairment. In the current study, we determined the association between VA and retinal layer metrics derived from optical coherence tomography images in patients with and without DME.Patients and methodsA case–control study was conducted on 216 eyes at the Department of Ophthalmology, Menoufia University Hospital. Group 1 included 40 eyes of type I diabetics, group 2 included 68 eyes of type II diabetics, and group 3 included 108 eyes of controls. Two subgroups of diabetic patients comprised 49 eyes with DME and 59 eyes without DME.Each patient underwent ophthalmic examination, VA, and optical coherence tomography.ResultsOur results revealed significant differences in best-corrected VA, a significant increase in the central foveal thickness, a significant increase of the temporal retinal nerve fiber layer thickness in diabetics, which was associated with reduced VA, and a significant thinning of the superior ganglion cell layer thickness.In patients with DME, we found a significant increase of the superior ganglion cell layer thickness and thinning of the nasal retinal nerve fiber layer thickness. These measurements as well as macular thickening were associated with reduced VA.ConclusionThe variations in retinal layer thickness were associated with reduced VA with and without DME.

ObjectivesTo present the various adverse effects of topical prostaglandin analogs on the periorbita.BackgroundThe authors studied the prostaglandin-related adverse effects on the periorbita and compared each analog in a sample of patients with glaucoma.Patients and methodsA case series study was performed on the adverse effects on the periorbita noticed in glaucomatous patients who were controlled by prostaglandin in Menoufia University Hospital and Cairo Fatemic Hospital. The study was done on 100 patients aged from 18 to 75 years at outpatient clinics.ResultsA total of 100 patients were found to have a variety of disorders, including deepening of the superior sulci (42/100), hypertrichosis (23/100), lengthening of eyelashes (48/100), and hyperpigmentation of the skin surrounding the eye (40/100).ConclusionAlthough topical prostaglandin analogs are well tolerated by many patients, some individuals who use these medications complain of structural changes in the periorbita, resulting in a variety of cosmetic and eyelid disorders, such as lengthening of eyelashes, hypertrichosis, hyperpigmentation of the skin surrounding the eye, and deepening of sulci.

Objective: To compare the effectiveness of endoscopic dacryocystorhinostomy with ologen implant versus endoscopic dacryocystorhinostomy with silicon tube implantation. Background: Chronic dacryocystitis is an inflammatory disorder of the lacrimal sac that is mostly accompanied by partial or total nasolacrimal duct obstruction. Watering and discharge are the most common symptoms, however some cases can escalate to serious ocular and extraocular complications. It can result in severe ocular morbidity and loss of productivity at work, as it can temporarily obscure vision, prevent a person from concentrating on their task, and be socially uncomfortable. The goal of this research is to find a way to reduce recurrence after DCR surgery. Methods : We conducted a prospective controlled study to evaluate effectiveness of endoscopic dacryocystorhinostomy with ologen implant versus endoscopic dacryocystorhinostomy with silicon tube implantation. A total of 40 patients underwent primary endoscopic DCR surgery in Menoufia University Hospital from march 2020 till march 2021. A total of 20 cases did endoscopic DCR using ologen implant (group A) and the other 20 cases did endoscopic DCR using silicon tube (group B). Results: The success rate, which was evaluated by MUNK score and syringing test, was compared between both groups also rate of complications like epistaxis, implant complications and post surgery synechiae was compared. Success rates was 75% in ologen group and 85%in the other group. Epistaxis, infection and post sugery synechiae were statistically in significant between the two groups but implant complications was more in ologen group than the other group. Conclusion: Endoscopic DCR with ologen implantation is not superior to endoscopic DCR with silicon stenting due to the challenging ologen implantation procedure and the high cost relative to silicon stenting.

ObjectivesTo evaluate and compare the outcomes of bicanalicular self-retaining stent (SRS) versus rectangular 3-snip punctoplasty in the treatment of acquired lower punctal stenosis.BackgroundPunctal stenosis is a common disorder and one of the most commonly encountered diseases that cause tearing. Visual disturbance occurs because of constant epiphora.Patients and methodsThis prospective randomized comparative study was carried on 65 eyes of 39 patients with acquired lower punctal stenosis. Patients were categorized into two groups based on the intervention, such as insertion of bicanalicular SRS (group A) and rectangular 3-snip punctoplasty (group B). Assessment of epiphora, punctal stenosis grading, and fluorescein dye disappearance test were performed preoperatively and postoperatively. Patients were followed up for 6 months postoperatively.ResultsGroup A, which included 34 eyes of 20 patients, showed anatomical success in 31 (91.2%) eyes and functional success in 32 (94.1%) eyes, whereas group B, which included 31 eyes of 19 patients, showed anatomical success in 26 (83.9%) eyes and functional success in 22 (71.0%) eyes. The difference in the functional success rate was clinically significant (P = 0.013).ConclusionBicanalicular SRS achieves better results than rectangular 3-snip punctoplasty in the treatment of acquired lower punctal stenosis.

OBJECTIVES:To evaluate the safety and efficacy of augmenting conjunctival autografting with intraoperative mitomycin C (MMC) application versus Ologen implantation in the management of recurrent pterygium.MATERIALS AND METHODS:This prospective randomised study included 63 eyes of 63 patients, with recurrent nasal pterygium, who presented to the outpatient clinic of Menoufia University Hospital in Shebin El Kom and Manshiet Soltan from January 2016 to December 2019. Patients were randomly enrolled into two groups. Group A included 32 eyes of 32 patients who underwent conjunctival autografting augmented with the topical application of MMC (0.2 mg/mL), and group B included 31 eyes of 31 patients who underwent conjunctival autografting augmented with Ologen implantation. All the patients underwent follow-up examinations for a period of 24 months. During each visit, a complete ophthalmic examination was performed. Pterygium regrowth of 1 mm or more, over the cornea, was considered a recurrence.RESULTS:In the MMC group, no recurrence was reported during the 24-month follow-up period. In the Ologen implantation group, recurrence was reported in 2 (8%) eyes. The time interval from surgery to recurrence was 5 months in one case and 8 months in the other. No other serious postoperative complications were reported, and there was no statistically significant difference between the groups in this regard.CONCLUSION:Ologen implantation with conjunctival autografting shows promising results in the surgical management of recurrent pterygium with mild non-vision-threatening postoperative complications comparable to that of MMC application with conjunctival autografting. Registration number: ClinicalTrials.govNCT04419038.

Aim is to evaluate surgical outcome of Triangular Three-snip Punctoplasty (TSP) with three interrupted sutures and compare it to conventional Triangular Three-snip Punctoplasty (TSP) in treatment of acquired lower punctal stenosis. Methods This prospective study included 40 eyelids of 24 patients with acquired lower punctal stenosis grade 1 or grade 2 were classified in two groups. Group A was treated by triangular 3-snip punctoplasty of the lower punctum followed by three interrupted sutures at the posterior ampulla and group B was treated by conventional triangular 3-snip punctoplasty of the lower punctum. Grade of epiphora and grade of FDDT were measured preoperative then post-operative after 1 week, 1 month, 3 months and 6 months. Success was defined as postoperative improvement of epiphora and FDDT grading with no restenosis to occur. Results from 20 eyelids in group A, 16 cases showed success (80%) with patent puncta, 2 cases (10%) showed no change and 2 cases (10%) showed failure with restenosis. While from 20 eyelids in group B, 14 cases showed success (60%) with patent puncta, 4 cases (20%) showed no change and 4 cases (20%) showed failure with restenosis. Conclusion proposed triangular 3-snip punctoplasty of the lower punctum followed by three interrupted sutures seems to have better results compared to conventional triangular 3-snip punctoplasty of the lower punctum in treatment of grade 1 or 2 lower punctal stenosis.

Purpose: To evaluate the recent intraoperative lagophthalmos formula method for levator resection in determining postoperative lid height in congenital ptosis on Egyptian patients. Methods: This is a prospective case series which included 20 eyelids of 17 Egyptian children with congenital ptosis whose levator function is 4 mm or better. They underwent levator muscle resection guided by the recently presented intraoperative lagophthalmos formula. Preoperative Margin-to-Reflex Distance 1 (MRD1) and levator function were measured then intraoperative palpebral fissure opening was determined from formula: Intraoperative lagophthalmos = 9.08 - (0.48 x Preoperative MRD1) - (0.26 x Levator function). Success was defined as postoperative MRD1 > 3 mm and difference between both eyelid height <= 1 mm at 6 months. Results: From 20 eyelids, there were five cases with mild (25%), 11 with moderate (55%), and four with severe (20%) ptosis. They showed success in four cases (80%), eight cases (73%), and three cases (75%) in each degree respectively with an overall success of 15 cases (75%). Conclusion: Proposed intraoperative lagophthalmos formula showed relatively good results in predicting postoperative eyelid level in Egyptian children with simple congenital ptosis with fair to good levator function.

Purpose The aim of this study was to evaluate the efficacy and safety of Botulinum toxin injection in the palpebral lobe of the lacrimal gland for treatment of epiphora. Patients and methods A total of 20 patients with epiphora (crocodile tears syndrome, lower lid laxity, malposition of the lower lid, and obstruction of lacrimal drainage system in which lacrimal surgery was impossible) received intralacrimal gland injection of Botulinum toxin (2.5 IU/0.1 ml). Follow-up was performed on the first day, first week, first month, third month, and sixth month after injection to evaluate the efficacy, safety, and occurrence of any complications and to record the rate of recurrence. Results Cure was successfully achieved in 60% of the patients after the first injection and in 90% of patients after the second injection. There were 15% of recurrent cases after the first injection, and there were no recurrent cases after the second injection. Temporary ptosis occurred in 10% of this study group after the first injection and in 5% after the second injection. There was a highly significant decrease in Schirmer’s test and tear meniscus height among the study group regarding the pre-injection and follow-up values (P<0.01). In addition, there was a highly significant decrease in Munk scale and time of dye disappearance test among the study group regarding the pre-injection and follow-up values (P<0.01). Conclusion The injection of Botulinum toxin in the palpebral lobe of the lacrimal gland was effective and safe as a temporary measure to reduce excessive tearing until a more permanent measure can be taken.

Objective To evaluate the effect of azithromycin 1.5% eyedrops versus moxifloxacin 0.5% eyedrops on bacterial conjunctivitis. Background Purulent bacterial conjunctivitis affects all ages, with high frequency in newborns and children. This study evaluates the effect of azithromycin 1.5% eyedrops with moxifloxacin 0.5% eyedrops in treatment of bacterial conjunctivitis. Patients and methods A prospective comparative randomized controlled clinical trial was conducted that included 100 participants with purulent bacterial conjunctivitis at Menoufia outpatient clinic. Patients received either azithromycin 1.5% eyedrops twice daily for 7 days or moxifloxacin 0.5% eyedrops three times per day for 7 days. The primary variable was clinical cure at days 3 and 7 on the worst eye. The cure was defined as absence of purulent discharge and bulbar conjunctivitis. Results Overall, 88% of patients in the azithromycin group and 90% in the moxifloxacin group were clinically cured at D7. Clinical cure with azithromycin was not inferior to moxifloxacin at day 7, and discharge was absent in 92% of patients treated with azithromycin and 94% with moxifloxacin. Azithromycin and moxifloxacin were well tolerated. Conclusion Azithromycin 1.5% for 7 days was as effective as moxifloxacin for 7 days. Furthermore, patients on azithromycin presented clinical cure on day 3 as patients on moxifloxacin.

Objective The aim was to evaluate the surgical effect of maximal levator muscle resection technique for moderate to severe simple congenital blepharoptosis with poor levator function. Background Surgical treatments for the correction of congenital ptosis with poor levator function including frontalis suspension or maximal levator resection remain controversial. However, the levator resection approach seems to be the most physiological. Maximal levator resection, assuming that it is employed appropriately, is highly effective in cases of moderate to severe congenital ptosis with poor levator function. This surgery advances and plicates the levator muscle, thus increasing its effect. Patients and methods This prospective study included 29 eyelids of 20 patients who underwent maximal levator resection procedure, and their ages ranged from 3 to 8 years. Patients who presented with ptosis were examined and enrolled from January 2018 to January 2019, from the Outpatient Ophthalmic Clinic of Menoufia University Hospital. Follow-up was done at first week, first month, and sixth month postoperatively to evaluate the functional, cosmetic results, and complications. Results There is a statistically significant increase of mean postoperative marginal reflex distance-1 (MRD-1) at first week, first month, and sixth month in comparison with preoperative MRD-1 (P Conclusion Maximal levator resection procedure is very effective in the treatment of simple congenital blepharoptosis with poor levator function.

Objectives To compare between the successes of probing using soft cannula (a 22 G) versus conventional probing in children with congenital nasolacrimal duct obstruction. Background Congenital obstruction of the nasolacrimal duct is a common problem in the early years of life. Obstruction can occur in 6–20% of neonates. The usual cause is failure of canalization of the epithelial cells that form the nasolacrimal duct as it enters the valve of Hasner. Patients and methods This prospective, randomized study was conducted on 36 children (48 eyes) having congenital nasolacrimal duct obstruction presented to the outpatient clinic of Menoufia University Hospital and Kafer El-Sheikh Ophthalmology Center from November 2016 to July 2018. The children were divided into two groups: group A, 18 children (24 eyes) operated by conventional probing and group B, 18 children (24 eyes) operated by probing using soft cannula. The patients were monitored for 6 months postoperatively. Results Clinically successful results were achieved in 20 eyes (83.4%) for conventional probing group and 19 eyes (79.2%) for soft cannula group. No significant complication occurred intraoperatively or postoperatively. Conclusion Soft cannula probing is an effective and simple method with no significant complication for the treatment of congenital nasolacrimal duct obstruction. This method allows probing in a more controlled way. However, there was no statistical difference between it and conventional probing.

ObjectivesThe aim of this study was to evaluate the intravitreal injection of antivascular endothelial growth factor of ranibizumab in patients with diabetic macular edema (DME).BackgroundThe study evaluated short-term and long-term effects of ranibizumab on the morphology and function of the retina.Patients and methodsFifty eyes of 44 patients with DME were enrolled in this prospective study. After intravitreal ranibizumab injection, central macular thickness (CMT) and best-corrected visual acuity (BCVA) were measured before, 1, 2, 3, and 6 months later.ResultsThe mean CMT and logarithm of minimum angle of resolution BCVA improved significantly (P < 0.001) after the first, second, and third injections. Three eyes did not show improvement in CMT while seven eyes did not show improvement in BCVA. The most significant (P < 0.0001) correlation in mean CMT and logarithm of minimum angle of resolution BCVA is seen after the first month. In addition, significant change is seen in CMT (P = 0.001, 0.002) and BCVA (P = 0.0001, 0.001) between the first and second month and second and third month, respectively. Three months after the last injection, mean CMT insignificantly (P = 0.24) increased, and mean BCVA insignificantly (P = 0.51) decreased, but they were still significant with baseline. There was a significant correlation (P < 0.001) between the mean change in CMT and BCVA at all stages of the study.ConclusionIn DME, intravitreal ranibizumab effectively decreased CMT as a structural aspect and hence improved BCVA as a functional aspect. Evaluation of the short-term effects of ranibizumab can predict the therapeutic outcome 1 month after injection.

ObjectiveThe objective of this study was to evaluate the indications, outcomes, and complications of keratoprosthesis (type I Boston keratoprosthesis) in end-stage corneal disease.BackgroundCorneal diseases are the leading cause of blindness worldwide, second after cataract. Eyes with deep corneal vascularization, limbal stem cell deficiency, autoimmune diseases, and chemical injury are prone to graft rejection. Keratoprosthesis offers visual rehabilitation in such situations.Patients and methodsIn this prospective clinical study, 10 eyes of 10 patients with an end-stage corneal disease underwent implantation of type I Boston keratoprosthesis, with a mean follow-up of 6.9 ± 1.4 months. The indications included multiple failed grafts (n = 6), ocular cicatricial pemphigoid (n = 3), and vascularized corneal opacity (n = 1). Antibiotic prophylaxis was administered postoperatively, and patients were followed up at 1 week, 1, 3, and 6 months. The main outcome measures were best-corrected visual acuity, retention of prosthesis, and complications.ResultsThe most common indication for keratoprosthesis implantation was graft failure (6/10, 60%). Mean best-corrected visual acuity improved significantly after the surgery (P = 0.018). Nine (90%) patients had final visual acuity of 20/200 or better. Ten (100%) of 10 patients had retained keratoprosthesis. Complications occurred in only two (20%) patients, where one (10%) patient had keratitis and one (10%) patient had peripheral corneal melting.ConclusionBoston keratoprosthesis provides improved vision for patients having corneal blindness owing to end-stage corneal diseases; however, long-term studies are needed to monitor the late-onset complications in the postoperative period.

Purpose . Evaluation of using pigtail probe to detect and open severely stenosed lower lacrimal punctum followed by self-retaining bicanalicular intubation. Study design . A prospective nonrandomized clinical study. Methods . The study included 24 patients with severe lower punctal stenosis (grade 0 according to Kashkouli scale) attending at Menoufia University Hospitals. The upper punctum and canaliculus were patent. All patients were complaining of epiphora and had a thorough ophthalmological examination including dye disappearance test and slit-lamp examination. Pigtail probe was used from patent upper punctum to detect the lower stenosed punctum which was opened with a scalpel. Syringing of the lower lacrimal passages was done to confirm its patency, and self-retaining silicone bicanalicular stent was inserted. The silicone tube was left in place for 6 months before it was removed. Patients were then followed-up for 1 year after the surgery. Results . One year after surgery, epiphora was absent (grade 0) in 16 eyes (66.7%) and was present only occasionally (grade 1) in 4 eyes (16.7%). The difference from preoperative epiphora was statistically significant. One year after surgery, fluorescein dye disappearance time was grade 1 (<3 minutes) in 20 cases (83.3%), and grade 2 (3–5 minutes) in 4 cases (16.7%). There was a statistically significant difference compared with preoperative results. Conclusion . Using the pigtail probe is effective in treatment of severe punctal stenosis. Maintaining the punctal opening and prevention of restenosis can be achieved by using self-retaining bicanalicular stent after confirmation of nasolacrimal duct patency. This trial is registered with NCT03731143 .