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

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

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

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