Use of the carbon dioxide laser for removal of lesions adjacent to the punctum.

Neoplasms, small or large, adjacent to the punctum can create a dilemma as to their removal and its repair. Punctal stenosis, total closure, and punctal ectropion are complications that can occur after surgery. Punctal complications can cause epiphora with secondary chronic blepharoconjunctivitis and skin excoriation due to chronic rubbing or wiping off of tears by the patient. This report will discuss carbon dioxide laser excision of neoplasms adjacent to the punctum. This laser approach provides a bloodless field, minimal postoperative pain, and good postoperative appearance without scar formation. Smaller adjacent lesions cause no punctal abnormality. Larger lesions adjacent to the punctum which have already caused ectropion did not worsen the ectropion postoperatively.