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rimal punctum protrusion have not been previously reported, and only a significant negative correlation between the severity of punctal protrusion and tear clearance has been reported in the literature [5]. The patient showed a lower eyelid laxity of grade 1 during the initial examination and it was unclear whether the inability to discharge tears was caused by protrusion. Early surgical treatment was attempted as the patient also raised cosmetic concerns. Epiphora improved considerably, and it was confirmed that the case was caused by decreased tear flow due to punctum protrusion. In conclusion, we report a case of epiphora caused by an abnormal lacrimal punctum position due to severe protrusion. The patient was successfully treated with a novel punctal fixation technique.

A Rare Case of Acute Ocular Hypertensive Episode in a Patient with Chronic Infantile Neurological Cutaneous Articular Syndrome