Abnormal lacrimal punctum morphology Punctal stenosis 2017-12-14T14:21:45Z Stenosis of the lacrimal punctum Lacrimal punctum stenosis Epiphora is a common complaint encountered by ophthalmologists, with a broad differential diagnosis. One of the least discussed etiologies of epiphora is stenosis of the external lacrimal punctum. When it occurs, the most common presenting symptom is tearing, but patients may have vague complaints of ocular discomfort. Punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded.