Kim and associates deserve appreciation for their article. They have introduced a simple logical solution to a common problem and a new means of assessment of the outcome. However, a few points require attention. In the “Results,” they mentioned “severe viral conjunctivitis (3 patients) and chronic blepharitis (2 patients)” as causes of punctual stenosis, in addition to other causes. They wrote that the patients with chronic blepharitis received warm compresses and antibiotic and steroid eye drops. The issue is that the improvement in epiphora and tear height (their outcome measures) in these cases may be the result of nonsurgical management and not because of the procedure.
Another concern regarding the destruction of the normal proximal part of the canaliculus in their procedure. Moreover, in the “Discussion,” they mentioned a temporary punctual plug or Mini Monaka stents (FCI Ophthalmics Inc, Issy-Les-Moulineaux, France) in case of failure, but they did not mention the options of dacryocystorhinostomy with bicanalicular silicon intubation or conjunctivodacryocystorhinostomy.
They had a follow-up of 6 months, which is very short, keeping in mind the chances of failure resulting from cicatrization in the long term. We maintain a silicon tube with a lumen (eg, a dacryocystorhinostomy [DCR] tube) in the canaliculus for a few months after punctoplasty to prevent restenosis. We anchor it at the punctum with sutures to prevent premature loss. I congratulate the authors again for publishing a very useful article.