Relieve Persistent Watery Eyes
With Punctoplasty
Tear Duct Opening Surgery (Punctal Stenosis Treatment)
Punctoplasty is a precise, minimally invasive procedure that widens a narrowed or blocked tear duct punctum, the small drainage opening at the inner corner of the eyelid. By restoring normal tear drainage, it provides lasting relief from epiphora (persistently watery eyes) with minimal downtime.
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Read About Our Happy Patients
I saw Professor Jeeva today for a consultation regarding lower blephoroplasty. I was made very welcome and put at ease. The procedure was explained to me and I was encouraged to ask as many questions I wanted. I wasn't made to feel rushed or pressured into anything and left feeling that if I do decide to proceed I will be in safe hands.
Alison SmithMy mum Maureen Astles had a Zoom consultation with Mr Jeeva this morning. What a lovely surgeon he was helpful informative and such a nice smile putting her totally at ease. She is now looking forward to meeting him in person for surgery as she knows she will be in the best hands for a successful outcome.
Catherine AstlesI would like to extend my heartfelt thanks to Mr Jeeva, my surgeon and all the doctors and staff at the centre. The care I received from start to finish was exceptional. I felt at ease and was reassured throughout the procedure, feeling safe the entire time. I cannot thank you enough and will definitely be recommending your services to family and friends.
Denise DouthwaiteWhat Is Punctoplasty? (Punctal Stenosis Surgery)
The punctum is the small opening at the inner corner of each eyelid margin through which tears enter the lacrimal drainage system. When this opening becomes narrowed (a condition called punctal stenosis), tears cannot drain at the normal rate and spill onto the cheek, causing persistent watery eyes (epiphora). This can blur vision temporarily, cause skin irritation, and affect daily activities and quality of life.
Punctoplasty surgically enlarges the punctal opening, restoring adequate drainage. It is the definitive treatment for symptomatic punctal stenosis and is indicated when conservative measures such as treatment of underlying blepharitis or a trial of lubricating drops have not resolved the problem.
The procedure is performed as a day case under local anaesthetic by our specialist oculoplastic consultant, and most patients notice a clear improvement in their symptoms within a few days of surgery.
Punctoplasty at a Glance
- Treatment Time: 15 to 30 minutes
- Anaesthesia: Topical drops and local anaesthetic injection
- Hospital Stay: Day case (no overnight stay)
- Recovery Time: 2 to 5 days
- Pain: Minimal
- Sessions Required: 1 in most cases
- Both Eyes: Can be treated at the same visit
- Cost: Contact us
Why Choose Punctoplasty?
Quick and Effective
Punctoplasty is a short, office-based procedure performed under local anaesthetic. Most patients notice a significant improvement in tearing within days of surgery.
Minimal Downtime
The procedure requires only a brief recovery period. Most patients are comfortable returning to normal daily activities within two to five days, with no hospital admission required.
Addresses the Root Cause
Rather than masking symptoms, punctoplasty surgically widens the narrowed punctum (the actual anatomical cause of impaired tear drainage), providing durable, lasting relief.
Who Is Punctoplasty Suitable For?
Punctoplasty is typically recommended for patients who have:
What to Expect
Punctoplasty at The Eye Doctor is a brief, carefully performed day-case procedure with a short, straightforward recovery.
Initial Consultation
A thorough slit-lamp examination of both puncta is performed to confirm the diagnosis of stenosis and grade its severity. Lacrimal irrigation (syringing) may be carried out to assess the patency of the canaliculi and nasolacrimal duct, ensuring that more distal obstruction is not also present. The clinical history, including any relevant medication use, is reviewed in full.
Surgical Technique
A single vertical incision through the posterior wall of the punctal ampulla is made with fine scissors. This creates a modest enlargement of the punctal opening and is suitable for mild stenosis.
Two incisions (one vertical and one horizontal) are made, and a small triangle of tissue is removed to create a wider, more permanent punctal opening. This is the most commonly performed technique, providing reliable and durable results.
A third incision is added to further enlarge the opening. This approach is reserved for more severe or recurrent stenosis where a greater degree of widening is required.
The Procedure
Topical anaesthetic eye drops are instilled, followed by a small injection of local anaesthetic around the punctum. The procedure is very well tolerated with minimal discomfort.
Using fine lacrimal scissors, the punctum is enlarged using the technique best suited to your degree of stenosis. The procedure takes approximately 15 to 30 minutes per eye and requires no sutures.
The lacrimal system is irrigated at the end of the procedure to confirm that the newly widened punctum allows free passage of fluid, and that no further downstream obstruction is present.
Post-Procedure Care
You are discharged shortly after the procedure. A short course of antibiotic eye drops is prescribed to reduce the risk of infection and support healing.
- Instil prescribed antibiotic eye drops as directed, typically for one week
- Avoid rubbing the inner corner of the eye for two weeks
- Do not wear eye makeup for at least one week
- Contact lens wearers should avoid lenses for one week
- Avoid swimming for two weeks
- If prostaglandin analogue drops triggered the stenosis, your ophthalmologist will advise whether these can be continued or should be changed
Risks and Complications
Punctoplasty is a low-risk minor procedure. Recognised complications include temporary increased watering immediately following surgery (as the punctum heals), infection, and re-stenosis requiring a repeat procedure. Very rarely, the canaliculus may be damaged, affecting drainage further. All risks are discussed at your pre-operative consultation.
Follow-Up
A follow-up appointment is arranged at approximately two to four weeks to assess the punctal opening, confirm adequate drainage, and review symptom improvement. Further review is scheduled if needed. If symptoms persist, additional investigation of the lacrimal system will be undertaken to exclude other causes of epiphora.
Benefits of Punctoplasty
Punctoplasty FAQs
Punctoplasty is a minor surgical procedure to widen the punctum, the small drainage opening at the inner corner of the upper or lower eyelid through which tears drain into the lacrimal system. When this opening becomes too narrow (a condition called punctal stenosis), tears cannot drain efficiently and overflow onto the cheek, causing persistent watery eyes (epiphora). Punctoplasty restores adequate drainage by creating a larger, permanent opening.
The most common causes include chronic eyelid inflammation (blepharitis or chronic conjunctivitis), prolonged use of certain eye drops (particularly prostaglandin analogues used for glaucoma), systemic or topical chemotherapy, radiotherapy to the face, and the natural narrowing that occurs with ageing. In many cases no specific cause is identified (idiopathic stenosis).
A diagnosis of punctal stenosis is made by an ophthalmologist using a slit lamp to directly inspect the punctum. If you have persistent watery eyes and the punctal opening appears visibly narrowed or cannot be easily entered with a lacrimal dilator, punctoplasty is likely to be recommended, provided more distal causes of obstruction have been excluded.
The most commonly performed technique is the 2-snip or 3-snip punctoplasty, in which one or two precise incisions open and enlarge the punctal ampulla. Simple punctal dilation (stretching the opening with dilators) may be used as a first-line measure for mild stenosis, though results tend to be less durable. Your surgeon will advise which approach is most appropriate based on the degree of stenosis and the anatomy of your tear drainage system.
Punctoplasty is performed using topical anaesthetic eye drops supplemented by a small local anaesthetic injection around the punctum. The procedure is very well tolerated and causes minimal discomfort. General anaesthesia is not required.
Prof. Irfan Jeeva
MBChB · FRCOphth · Professor of Ophthalmology
Professor of Ophthalmology & Consultant Ophthalmologist
Prof. Irfan Jeeva is a Professor of Ophthalmology and Consultant Ophthalmologist with specialist expertise in oculoplastic and eyelid surgery and paediatric ophthalmology. He has extensive experience managing complex eyelid conditions, strabismus, and amblyopia, combining academic rigour with compassionate clinical care. Prof. Jeeva brings a wealth of knowledge from his academic and clinical career to deliver outstanding outcomes for patients of all ages.
Meet the Team
Where to Find Us
Three convenient locations across West Yorkshire. Visit us for consultations, diagnostics, and treatments.
Bolton
136 – 140 Newport St
Bolton, Greater Manchester
BL3 6AB
Huddersfield
Woodlands, 4 Longbow Close
Huddersfield, HD2 1GQ
Stop Living With Watery Eyes
Book a consultation with our specialist oculoplastic team for a thorough assessment and a personalised treatment plan. Call +44 1484 627779 or book online.
