Three snip vs. two snip punctoplasty
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This is Richard Allen at the University of Iowa. This video demonstrates the difference between a three snip and two snip punctoplasty. A Crawford stent has been placed. For a three snip punctoplasty, Westcott scissors are used to make a vertical incision along the lateral portion of the punctum. This is followed by an additional vertical incision along the medial portion of the punctum. A horizontal incision inferiorly connects the two incisions. This effectively enlarges the punctum from the posterior surface of the eyelid. Hemostasis is not necessary. Attention is then directed to the opposite side where a two snip punctoplasty will be performed. A vertical incision is made along the lateral aspect of the punctum. A diagonal incision is then made from the inferior aspect of the vertical incision to the medial edge of the punctum. This enlarges the punctum from the posterior surface of the eyelid.