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New research · Ophthalmology
Journal of clinical medicine · 22h
Cohort studyJournal of clinical medicine · 2026

Evaluating Lacrimal Punctum Size as a Clinical Indicator of Dry Eye Disease Severity in a Real-World Lebanese Cohort.

Yehya Tlaiss, John Warrak, Elias Warrak
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OphthalmologyCohort study

Larger lacrimal punctal diameter is associated with greater tear film instability.

Evaluating Lacrimal Punctum Size as a Clinical Indicator of Dry Eye Disease Severity in a Real-World Lebanese Cohort.

Yehya Tlaiss et al. · Journal of clinical medicine · 2026
Background

To investigate the relationship between lacrimal punctum size and the severity of dry eye disease (DED) in a clinically refractory, real-world patient cohort from a tertiary ophthalmology center in Lebanon.

Methods

A retrospective observational study was conducted at Advanced Eye Care Center, Beirut, Lebanon (2016-2024).

n = 312 eyes
Results
Larger tear duct opening size means greater tear film instability
n = 312 eyes
More results

Kruskal-Wallis analysis confirmed significant inter-group differences (H = 140.1, p < 0.001).

All post hoc pairwise comparisons remained significant after Bonferroni correction ( p < 0.001).

“
Conclusion · 1 of 3

In this treatment-refractory cohort, larger lacrimal punctal diameter was significantly associated with greater tear film instability.

Conclusion · 2 of 3

These findings suggest that lacrimal punctal diameter estimation during therapeutic plug insertion may serve as a practical, cost-free adjunct to standard DED evaluation.

Conclusion · 3 of 3

Prospective multimodal studies are needed to validate punctal diameter as an independent clinical indicator of DED severity.

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