We thank Dr Shoaib for his interest in our article and wish to clarify his concerns regarding our study. First, the patients whose severe punctal stenosis was caused by viral conjunctivitis and chronic blepharitis already had been treated when the tear meniscus height measurement and punctoplasty were carried out. Accordingly, those problems have nothing to do with the study results, such as tear meniscus height.
Second, with regard to the destruction of canalicular structure, it does not seem to have a significant effect on tear clearing, as mentioned in the “Discussion.” We may carry out additional research on the mechanism in the future.
Polyvinylpyrrolidone (PVP)-coated silicone perforated punctal plug (FCI Ophthalmics Inc, Issy-Les-Moulineaux, France) or Mini-Monoka monocanalicular stent (FCI Ophthalmics Inc) can be a simple method available as an option in case of failure, and if epiphora is not solved completely, dacryocystorhinostomy or conjunctivo-dacryocystorhinostomy can be applied as the next step. In addition, the author’s method, namely suturing the silicone tube for preventing restenosis, can be considered as another good method.
As the author commented, the 6 months of follow-up in this study may not be enough to be called a long-term follow-up. We would carry out further evaluation of the patients for recurrence of stenosis. However, this study evaluated the patient condition uniformly after 6 months, unlike previous studies in which the follow-up period varied from several weeks to several months. In this sense, our results could be considered meaningful. Again, we appreciate the constructive remarks.