Purpose To examine the clinical presentation, histopathological characteristics and surgical success of patients that underwent Kelly punch punctoplasty. Methods A retrospective consecutive case series of all patients diagnosed with punctal stenosis and referred to Kelly punch punctoplasty and mini-monoka insertion between January 2017 and December 2017. The demographic, clinical and prognosis parameters were retrieved and analyzed. Moreover, a histopathological examination was performed on the tissue retrieved from the Kelly punch at the end of the procedure in order to evaluate the presence of muscle in the tissue, as well as chronic inflammation. Results The series was composed of 44 eyes of 28 patients. All patients’ complaints prior to surgery were epiphora: 18 patients had bilateral epiphora, 5 presented with right-eye epiphora and 5 with left-eye epiphora. The average Munk degree of epiphora before surgery was 3 and at least 3 months after surgery 1.04 (matched pairs, p < 0.0001). Two patients underwent the second punctoplasty. In haematoxylin and eosin staining, the Riolan muscle was not visible in the mucosal layer in 40 specimens. In four specimens, the muscle was observed. A Masson's trichrome staining ensured that the Riolan muscle existed only in those four specimens. Discussion Kelly punch punctoplasty is a simple and minimally invasive procedure for punctal dilation with high functional success rate. Moreover, in histopathological specimens, in all but four of the cases there was no muscle indicated. Intact Riolan muscle enables the punctum to stay in the right circular shape and position, and the lacrimal pump to maintain its pressure gradient.

中文翻译：

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Kelly穿孔成形术的临床和组织病理学特点

目的检查凯利穿孔穿刺成形术患者的临床表现、组织病理学特征和手术成功率。方法对2017年1月至2017年12月间所有诊断为泪小管狭窄并转诊为Kelly穿孔成形术和mini-monoka插入术的患者进行回顾性连续病例系列研究，检索并分析人口统计学、临床和预后参数。此外，在手术结束时对从凯利拳中取出的组织进行了组织病理学检查，以评估组织中肌肉的存在以及慢性炎症。结果该系列由28例患者44只眼组成。所有患者术前主诉均为溢泪：18例患者双侧溢泪，5 例出现右眼溢泪，5 例出现左眼溢泪。手术前 3 个月和至少 3 个月后的平均 Munk 溢泪度为 1.04（匹配对，p < 0.0001）。两名患者接受了第二次穿刺成形术。在苏木精和伊红染色中，40 个标本的粘膜层中未见 Riolan 肌肉。在四个样本中，观察到肌肉。马森三色染色确保里奥兰肌肉仅存在于这四个样本中。讨论 Kelly 穿孔穿刺成形术是一种简单、微创的泪点扩张手术，功能成功率高。此外，在组织病理学标本中，除了四个病例外，所有病例均未显示肌肉。完整的 Riolan 肌肉使泪点保持在正确的圆形形状和位置，