Punctal agenesis: Embryology, presentation, management modalities and outcomes.

Punctal agenesis is defined as the absence of the punctum occurring secondary to a failure of embryogenesis. This review synthesizes existing data on the embryology, anatomy, clinical presentation, symptomatology, management options and treatment outcomes of punctal agenesis. A foundational knowledge of the underlying embryologic and anatomical abnormalities is fundamental to understanding its clinical presentation and assists in choosing an appropriate management strategy. Existing outcomes data is generally favorable and suggests management with a step-wise approach can alleviate symptoms in patients across a spectrum of disease.