We read with interest the article published by Hussain, Kanani and McMullan entitled ‘Use of mini-monoka stents for punctal/canalicular stenosis’ in the British Journal of Ophthalmology.1 We have recently reviewed the clinical notes and completed a telephone-based questionnaire for our own patients who have undergone a similar procedure, although in our case we also performed a one-snip punctoplasty as described by Kashkouli et al.2 Our method and results may also be of interest to your readers.

The means by which ‘success’ is measured following such procedures is an important part of the study methodology. Hussain et al used ‘improvement of symptoms’ as their primary outcome measure, but the means by which this was assessed was not described in the paper. Patient benefit from surgery can be measured in many ways including; clinical …