Topical Cyclosporine and Steroid Treatments: A Comparative Approach to Membranous Punctal Stenosis

<b><i>Purpose:</i></b> To compare the efficacy of topical cyclosporine A (CsA) and steroid treatment in the membranous punctal stenosis (PS). <b><i>Methods:</i></b> Forty-eight patients with membranous PS were divided into 2 groups: 23 eyes of 13 patients received topical CsA for 6 months as Group CsA and 25 eyes of 14 patients received topical steroid for 3 months as Group S. Examinations were performed before and at 1, 3, 6, and 9 months after treatment. Clinical evaluations involved the Munk score and the fluorescein dye disappearance test (FDDT). Anterior segment optical coherence tomography was employed to measure tear meniscus height (TMH), tear meniscus area (TMA), and outer punctum diameter (OPD). TMH was also examined with biomicroscopy (TMH-Bio). A questionnaire was administered to assess patient satisfaction. <b><i>Results:</i></b> Munk score and FDDT grade decreased in both groups at all follow-ups compared with the pre-treatment. TMH-Bio was lower in the Group CsA at all follow-up visits compared with baseline (<i>P</i> < 0.001). TMA and TMH decreased in the Group CsA compared with pre-treatment at 6 months after treatment, whereas there were no changes in the Group S. OPD was larger at 9 months in both groups compared with baseline. The patients' satisfaction was higher in Group CsA at the 6th month compared with Group S. <b><i>Conclusions:</i></b> CsA has demonstrated the potential to be a more effective treatment option for the management of PS, with additional advantages compared with topical steroid, such as higher patient satisfaction and favorable functional outcomes.