Case report
Bilateral Punctal Stenosis Following Netarsudil Therapy in Fuchs Endothelial Dystrophy: A Case Report
Correspondence Address :
Dr. Gautami Ramesh Laturkar,
Resident, Department of Ophthalmology, Dr. D.Y. Patil University, Pune-411018, Maharashtra, India.
E-mail: grlaturkar@gmail.com
Netarsudil, a Rho-Associated Protein Kinase (ROCK) inhibitor, is being increasingly used in the management of glaucoma and corneal endothelial disorders. Although conjunctival hyperaemia and corneal verticillata are well-recognised adverse effects, lacrimal drainage abnormalities have rarely been reported. The authors described a 52-year-old male with Fuchs endothelial dystrophy who developed progressive bilateral epiphora and punctal stenosis following initiation of topical Netarsudil 0.02% eye drops. The patient developed worsening watering and redness approximately four months after initiation of therapy. Slit-lamp examination revealed bilateral conjunctival congestion, corneal guttae with stromal oedema and cicatricial narrowing of both upper and lower puncta. Specular microscopy demonstrated reduced endothelial cell density bilaterally, while anterior segment optical coherence tomography showed increased central corneal thickness. Other causes of acquired punctal stenosis including trauma, autoimmune disease, cicatrising conjunctivitis, Stevens-Johnson syndrome and alternative medication-induced aetiologies were excluded clinically. Despite discontinuation of Netarsudil and initiation of preservative-free lubricants, punctal fibrosis persisted, necessitating bilateral punctoplasty with symptomatic improvement on follow-up. The temporal relationship with drug initiation, exclusion of alternate aetiologies and stabilisation after discontinuation supported a probable adverse drug reaction according to World Health Organisation – Uppsala Monitoring Centre (WHO-UMC) causality assessment criteria. The present case highlights a rare but clinically significant adverse effect associated with Netarsudil therapy and emphasises the importance of early recognition and punctal evaluation in patients receiving prolonged ROCK inhibitor therapy.
Corneal oedema, Drug toxicity, Epiphora, Keratopathy, Lacrimal drainage obstruction
DOI: 10.7860/JCDR/2026/88699.24416
Date of Submission: Mar 03, 2026
Date of Peer Review: May 12, 2026
Date of Acceptance: Jun 15, 2026
Date of Publishing: Sep 01, 2026
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 29, 2026
• Manual Googling: Jun 11, 2026
• iThenticate Software: Jun 13, 2026 (1%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com
