Netarsudil used for treating glaucoma tied with Punctal stenosis: Study

A study was conducted to report a series of patients who developed punctal stenosis secondary to the use of topical netarsudil for the treatment of glaucoma.

Patients using topical netarsudil for management of glaucoma and noted to have punctal stenosis ipsilateral to the eye(s) being treated with netarsudil were included. Each enrolled patients' chart was reviewed and alternative causes of punctal stenosis were sought. Photographs were obtained to document punctal stenosis for some patients. Presence of punctal stenosis after topical netarsudil use, and resolution of punctal stenosis after cessation of therapy.

Results:

Sixteen patients had punctal stenosis; 13 developed unilateral punctal stenosis while using netarsudil unilaterally, and 3 patients developed bilateral punctal stenosis with bilateral use. The time from initiation of netarsudil to recognition of symptoms or documentation of punctal stenosis ranged from 2 to 35 months (median 12, mean 14.0 ± 8.7 months). Thirteen patients endorsed tearing, but two had no symptoms. Ectropion was seen in one eye. Corneal verticillata was noted in 14 (87.5%) patients. In 8 cases, netarsudil was discontinued and the punctal stenosis was reversed, with a resolution of associated symptoms.

Thus, Netarsudil use can lead to the development of reversible punctal stenosis. This inflammation-mediated stenosis may cause tearing and associated symptoms and may be sufficiently severe to require discontinuation of treatment. In this case series, all patients who discontinued treatment had a reversal of their punctal stenosis and associated symptoms.

Reference:

Punctal stenosis associated with topical netarsudil use by Thomas M. Meirick, et al. published in the Ophthalmology.

https://doi.org/10.1016/j.ophtha.2022.02.025

Keywords:

Netarsudil, adverse side effects, Glaucoma, Punctal stenosis, topical application, topical netarsudil, Thomas M. Meirick, Raghu C. Mudumbai, Matthew M. Zhang, Philip P. Chen, Ophthalmology, side effect, tearing, nasolacrimal duct obstruction