A Meta-analysis on the management options of Idiopathic Inflammatory Punctal Stenosis

Introduction: Punctal obstruction is the narrowing or complete blocking of the external opening of the lacrimal canaliculus. Acquired punctal obstruction with profuse epiphora is a rather common illness, with a prevalence ranging from 8.3% to 54.3%. Aim of the study: Aim of the study: To perform a meta-analysis on the management options for idiopathic inflammatory pyloric stenosis. Subjects and Methods: This meta-analysis follows the PRISMA flow diagram. We searched PubMed, Cochrane, Web of Science, Embase, and local databases for relevant clinical trials evaluating the management of idiopathic inflammatory punctal stenosis. The analysis was performed using the risk ratio (RR) for dichotomous data and the mean difference (MD) for continuous data, in addition to the 95% confidence interval (CI). The data were considered homogenous if the I2 was 50% and heterogenous if the I2 was > 50%. Results: Results showed significantly improved punctal staging in groups (I) and (III) compared to baseline, ( P = 0.007 and 0.017, respectively). However, no significant improvement was observed in group II. The relative risk (RR) across all groups was 1.68 (95% CI: 1.03, 2.75, P = 0.04 ), indicating a significant improvement in the treatment at the assessment time. The analysis of individual stages showed that the treatment effect varied across stages, with a significant improvement observed in stage 3. The study also found a substantial increase in Outer Punctal Diameter (OPD) in the groups (I) and (III) immediately after the treatment compared to baseline, with a pooled effect size of -58.22 (95% CI: -108.50, -7.93, P = 0.02 ). Conclusions: Dexamethasone (0.1% non-preserved, 0.4% non-preserved) showed an effective, symptom-relieving, and outer punctal diameter (OPD) improvement as compared with the 0.1% preserved dexamethasone; on the other hand, the 0.4% non-preserved dexamethasone carried more risk of increasing the intra-ocular pressure (IOP).