Epiphora: Successful Response to Systemic Steroids vs Topical Steroids

Purpose: Topical steroids are considered to be the first line of treatment for some forms of idiopathic punctal stenosis causing epiphora. We present a case of epiphora, which was unresponsive to the traditional management, but responded to one week of systemic steroids.

Observations: 48 year old male with no significant past medical history was referred for excessive tearing. Earlier, an ophthalmologist had prescribed Pataday and Zylet eye drops for both eyes after the patient complained about eye redness unilaterally. After a week without much improvement, Alrex and Azasite eye drops replaced them. Eye redness disappeared within a week, the patient then complained of excessive tearing. He was referred to a reconstructive ophthalmologist for treatment of possible punctal stenosis. On examination, the height of tear meniscus was increased, and diagnostic lacrimal probing of the lacrimal drainage system demonstrated both lacrimal drainage systems patent. Punctal stenosis was diagnosed. Over the next few weeks, patient underwent multiple syringing of the lacrimal duct system with temporary relief of symptoms. Tobradex was also prescribed for a month. Eye drops helped for the duration of treatment, but symptoms returned within a few days of discontinuation. However, intra ocular pressure began rising with Tobradex eye drops, so they were discontinued immediately. After three months of treatment and continuation of debilitating symptoms of epiphora, patient considered surgical intervention and consulted an ENT for second opinion. The ENT surgeon suggested Medrol Pack (Prednisolone) for a week as the patient had responded to the topical steroids, which increased his intra-ocular pressure. After four days of treatment, patient’s symptoms disappeared. By the seventh day, his eyes were back to normal with complete disappearance of epiphora symptoms.

Conclusions and Importance: Systemic steroids can be beneficial in patients suffering from idiopathic/iatrogenic punctal stenosis unresponsive to topical steroids and conventional treatments.


Ali Arif* and Humara Gull

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