{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:20:46Z","timestamp":1783596046555,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":189,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Ophthalmology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Punctoplasty is the standard surgical treatment for punctal stenosis; however, underlying canalicular abnormalities may significantly impact functional outcomes. This study evaluates the frequency and nature of proximal canalicular pathologies in patients with severe punctal stenosis (Grade 0 or 1) undergoing snip punctoplasty without stent or plug implantation and explores their relationship with surgical success.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included patients with Grade 0 or 1 punctal stenosis who underwent snip punctoplasty at Izmir Tepecik Training and Research Hospital between 2017 and 2023. Patients with systemic diseases, prior lacrimal surgeries, or nasolacrimal duct obstructions beyond the common were excluded. Punctoplasty was performed using the three\u2010snip technique without the use of punctal plugs or Mini\u2010Monoka stents. Intraoperative probing and lacrimal lavage were used to evaluate canalicular patency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 312 patients (516 eyes) were included. Surgical success was achieved in 396 eyes (76.74%). Failure occurred in 120 eyes (23.26%), with proximal canalicular stenosis being the most common associated pathology (38.33%), followed by mid\u2010canalicular (26.67%) obstructions. Since we exclusively included patients with Grade 0\u20101 punctal stenosis, the relatively lower functional success observed in our cohort may reflect a higher underlying prevalence of canalicular pathology in this subgroup. This supports the hypothesis that advanced punctal stenosis is frequently accompanied by additional proximal lacrimal abnormalities, potentially contributing to surgical failure. Failure was significantly associated with increasing age, especially in patients \u2265 60\u2009years (28.7%) compared to patients &lt; 60\u2009years (15.2%). Gender was not a significant factor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although anatomical patency can be achieved with snip punctoplasty, functional success is often compromised by unrecognized canalicular abnormalities\u2014particularly in patients with severe punctal stenosis. Chronic ocular inflammation and fibrosis may affect both the punctum and canalicular pathway. Adjunctive use of Mini\u2010Monoka stents should be considered to address deeper canalicular disease. Future prospective studies with standardized symptom scores and extended follow\u2010up are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/joph\/7692939","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:29:59Z","timestamp":1783592999000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Proximal Nasolacrimal Abnormalities on the Surgical Outcomes of Punctal Stenosis"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7537-2672","authenticated-orcid":false,"given":"Emre","family":"Ayintap","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1195-4830","authenticated-orcid":false,"given":"Mehmet Ali","family":"Doran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2653-6562","authenticated-orcid":false,"given":"Hasan","family":"Aytogan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"publisher","DOI":"10.2147\/opth.s31904"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/icu.0b013e32832ec3e0"},{"key":"e_1_2_13_3_2","first-page":"601","article-title":"Results of Dacryocystorhinostomy Analysis of Causes for Failure","volume":"93","author":"Welham R. 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