Abstract
Purpose :
To report a series of patients who developed punctal stenosis secondary to the use of topical netarsudil for treatment of glaucoma.
Methods :
Patients using topical netarsudil for management of glaucoma and noted to have punctal stenosis ipsilateral to the eye(s) being treated with netarsudil were included. Each chart was reviewed to identify other potential causes of punctal stenosis and result of cessation of netarsudil.
Results :
Sixteen patients had punctal stenosis; 13 developed unilateral punctal stenosis while using netarsudil unilaterally, and 3 patients developed bilateral punctal stenosis with bilateral use. Time from initiation of netarsudil to recognition of symptoms or documrntation of punctal stenosis ranged 2 to 35 months (mean 14.0 ± 8.7 months). Thirteen patients endorsed tearing, but two had no symptoms. Ectropion was seen in one eye. Corneal verticillata was noted in 14 (87.5%) patients. In 8 eyes, netarsudil was discontinued and the punctal stenosis was reversed, with resolution of associated symptoms.
Conclusions :
Netarsudil use can lead to the development of reversible punctal stenosis, which may cause tearing and associated symptoms and which may be sufficiently severe as to require discontinuation of treatment. Patients reporting these symptoms while using netarsudil should not be assumed to have dry eye disease, ocular surface toxicity from topical medications, or other forms of acquired punctal stenosis.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.