Fig. 1

Surgical procedure for the placement of three ties after rectangular three-snip punctoplasty. a The first vertical snip at the vertical canaliculus, (b) the second vertical snip made from the edge of the first snip to create a flap, (c) the final horizontal snip at the base, and (d) the three interrupted sutures being placed at the posterior wall of the ampulla after the rectangular three-snip punctoplasty. e For the three sutures, the inner surface of the canaliculus was slightly everted to allow sewing to the edge of the tarsal conjunctiva. f Immediate postoperative photograph. Note the three interrupted sutures, which are placed at the posterior wall of the ampulla