AIM: To evaluate the role of medical treatment in the management of inflammatory punctum stenosis guided by spectral domain anterior segment optical coherence tomography (OCT). METHODS: This prospective study included 60 patients complaining of epiphora due to inflammatory punctual stenosis. They were divided into two groups: Group A (30 patients) treated with a combination of preservative free hydrocortisone sodium phosphate 3.35 mg/mL eye drops, and preservative free artificial tears based on sodium hyaluronate, polyethylene and propylene Glycol; Group B (30 patients) treated with the same preservative free artificial tears only. Thirty normal subjects were included for comparison of pre-treatment anatomical parameters. Before starting treatment, all patients underwent anterior segment assessment including slit lamp examination, measurement of intraocular pressure (IOP), fluorescein dye disappearance test, and measurement of the outer punctum diameter (OPD) by Spectral domain anterior segment OCT. All assessments were repeated at each follow up done at 1 and 3mo later, together with subjective evaluation of patient’s satisfaction of the treatment outcome by simple rating questionnaire. RESULTS: Punctual diameter increased significantly with treatment in both groups (P<0.0001); although the widening was more in Group A as compared to group B (16.2% vs 8% of the original punctual size, mean difference of 28.933 μm, P=0.0076). Subjective satisfaction with treatment outcome was also better in group A (70% vs 40%, Chi-square P=0.0397). CONCLUSION: A combination of preservative free steroid eye drops and artificial tears causes significant widening of inflammed stenotic punctae and improvement of the associated epiphora.