Netarsudil use for glaucoma may cause punctal stenosis

Use of topical netarsudil 0.02% for the treatment of glaucoma results in the development of reversible punctal stenosis, a recent study has found. This inflammation-mediated stenosis can cause tearing and related symptoms and may lead to treatment discontinuation with sufficient severity.

In this study, the authors reported a series of patients who developed punctal stenosis secondary to the use of topical netarsudil 0.02% for glaucoma treatment. They also reviewed each patient’s chart and sought alternative cause of punctal stenosis. Finally, photographs were collected to document punctal stenosis for some patients.

The main outcomes measured were the presence of punctal stenosis following use of topical netarsudil and the resolution of such condition after treatment discontinuation.

Punctal stenosis occurred in 16 patients, of whom 13 developed unilateral punctal stenosis while using netarsudil unilaterally and three developed bilateral punctal stenosis with bilateral use. Time from treatment initiation to symptom onset ranged from 2 to 35 months (median 12 months).

Thirteen patients experienced tearing, but two showed no symptoms. Ectropion was also reported in one eye, and 14 patients (87.5 percent) were found to have corneal verticillate.

Netarsudil use was stopped in eight patients, and the punctal stenosis was reversed, resulting in the resolution of related symptoms.

“In this case series, all patients who discontinued treatment had reversal of their punctal stenosis and associated symptoms,” the authors said.