Objective: Review the literature on the current state of the art in diagnosing and treating epiphora caused by high lacrimal duct obstruction. Background: Punctal stenosis represents 3% to 17% of all lacrimal duct pathologies. Congenital or acquired, it can be secondary to entities such as age, climacteric age, systemic or topical medications, infections, palpebral malpositions, trauma, and tumors. It produces epiphora in 94% of the patients who present it. Review of Results: There is an increased prevalence between 40 and 70 years of age. The mean age at presentation is 53.8 +/- 11.8 years, consistent with several case series. The anatomical success rate following a puntoplasty varies from 31.2% to 96.2%, while the functional success rate varies from 18.7 to 93.3%. Inflammation and subsequent fibrosis are frequent findings, producing restenosis and tertiary obstructions. Topical cyclosporin A decreases T-lymphocyte production and cytokine release and mediates the inflammatory and immune response. Nassief et al. in 2024 published a prospective study of 26 patients with severe punctal stenosis. By the third month of treatment, there was an improvement in 100% of the patients, with absence of epiphora in 26% (Munk 0) and occasional epiphora in 74% (Munk 1). Conclusion: Punctal stenosis is triggered as an almost immediate response to a noxious stimulus. It is followed by inflammation, edema, keratinization of the conjunctiva, and scarring of the lacrimal puncta and other parts of the lacrimal duct. Routine dilatations and punctal punctures are discouraged as initial treatment, as they perpetuate the cycle of inflammation and increase the risk of restenosis. Clinical Importance: Cyclosporin A may play a decisive role in the treatment and prognosis of punctal stenosis, considering the pathophysiological mechanisms that originate and perpetuate its narrowing and obstruction.