Prevalence and associations of external punctal stenosis in a general population in Spain

To determine the prevalence of external punctal stenosis (EPS) and to investigate its associations in a general adult population in northwestern Spain.

A total of 1155 subjects ≥ 40 years were selected by an age-stratified random sample procedure in O Salnés (Spain). An interview was carried out to collect history of systemic diseases and lifestyle details, and a comprehensive ophthalmic evaluation in which EPS was recorded. The prevalence of EPS and its relationship with demographic, lifestyle, and systemic and ocular factors was investigated. All calculations were weighted to give unbiased estimates.

From 937 eligible subjects, 621 (66.3%) participated [mean age (SD), 63.4 (14.5) years; range, 40-96 years; 37.0% men). The prevalence of EPS was 17.3% [95% confidence interval (CI), 14.8-19.8). This prevalence increased significantly with aging (P = 0.000) and was 13.8% (95% CI, 10.3-18.3) in men and 19.4% (95% CI, 16.1-23.2) in women. After controlling for age and sex, EPS was associated with outdoor occupational activity (age and sex adjusted odd ratio [ORa], 2.22; 95% CI, 1.31-3.37) and with degenerative disorders such as pinguecula (ORa, 1.48; 95% CI, 1.15-1.89) but not with inflammatory disorders such as blepharitis or dry eye. A multivariable analysis in which sex differences also became significant (P = 0.024) confirmed these associations.

External punctual stenosis is a common disorder associated with outdoor occupational activity. Processes associated with tissue degeneration but not with inflammation are highly prevalent among subjects with EPS. Modifiable factors, such as sun exposure, must be addressed to reduce the impact of this disorder.