الفهرس 
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Abstract
Aquired inflammatory punctal stenosis is a disease commonly presented with epiphora and most common cause is long term treatment with preservative containing topical eye drops.
The inflammation causes a decrease in the clearance of the medication and preservative, and their continued use will result in more inflammation and stenosis, and therefore a longer clearance time resulting in a higher concentration and longer transit time, leading to a vicious cycle.
The inflammation and fibrosis of the lacrimal drainage system causes extensive fibrous adhesions that obstruct the canaliculi and lacrimal sac. These drugs and similar ones cause damage to the mucosal lining, which occasionally may cause permanent damage to the lacrimal system. The ocular abnormalities are most likely secondary to the inhibition of cellular proliferation in the conjunctiva, cornea, and the eyelid, that generally occurs within days to weeks of the initiation of treatment. These complications will usually resolve after the treatment is completed.
All preservatives, even at very low concentrations, appeared cytotoxic for ocular cells.
Summary
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This study was conducted to detect the effectiveness of topical preservative free steroids eye drops in treatment of inflammatory punctal stenosis in a sample of Egyptian people.
This prospective comparative study comprised 40 eyes with punctal edema and 20 eyes from normal individuals as a control group.
group A: 20 eyes Patients in this group received preservative free hydrocortisone 2.5% eye drops 4 times daily for 1 week with tapering over 3 weeks and followed up after 1 month. And after 3 months.
group B: 20 eyes Patients in this group received one of the preservative free artificial tears available in market (preservative free systane ultra eye drops) 4 times/day for 1 month.
Control group: 20 eyes from normal individuals as a control group.
All subjects were subjected to history taking, slit lamp examination, Flourescene dye disappearance test for diagnosis and follow up once/month for 3 months and measuring the punctal diameter pretreatment, after 1 month and after 3 months from treatment.
Summary
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Both Groups showed highly statistically significant increase in punctal diameter compared to the control group at 1 month and at 3 months follow up after treatment.
Comparing group A and group B, the study found that there was a highly statistically significant symptomatic improvement after 3 months in preservative free steroids group more than the preservative free artificial tears group