Snip punctoplasty offers little additive benefit to lower eyelid tightening in the treatment of pure lacrimal pump failure.

Lacrimal pump failure refers to epiphora due to reduced tear outflow in the presence of a patent lacrimal drainage system and well-positioned puncta. This condition has been managed with dacryocystorhinostomy and lower eyelid tightening, which carry success rates of 50-94% and 84-91%, respectively. In this retrospective study, 23 eyes with symptomatic epiphora attributed to lacrimal pump failure underwent the lateral tarsal strip procedure and lower eyelid snip punctoplasty, and 20 eyes (87%) experienced complete or nearly complete resolution of tearing. This success rate is quite similar to that of prior studies of eyelid tightening alone for lacrimal pump failure, suggesting that the addition of the snip punctoplasty may not offer any additional benefit in patients with little or no punctal stenosis. All patients displayed some degree of lower eyelid laxity on lid distraction testing preoperatively, and those with only mild lid laxity responded at least as well as those with more severe laxity.