PURPOSE: To evaluate the effect of cyclosporine-A (CsA) 0.05% eye drops for management of acquired punctal stenosis, either alone or in combination with punctoplasty. METHODS: In this prospective study patients referred to the oculoplastics clinic with acquired punctal stenosis (APS) were divided into three groups. Group A consisted of patients treated with CsA, Group B consisted of patients who underwent punctoplasty, and Group C included patients treated with both CsA and punctoplasty. Munk score, fluorescein dye disappearence test (FDDT), punctal opening grading were evaluated at baseline, and at the 1st and 6th month follow-ups. RESULTS: One hundred-eleven eyes of 80 patients were included in the study. While the punctum grade was significantly higher, the FDDT grade and Munk scores were significantly lower in group C compared to groups A and B at the 1st and 6th month follow-ups. The functional success rate was 69%, 79%, and 88% ( CONCLUSIONS: In the treatment of APS, the use of CsA alone and the punctoplasty procedure demonstrated comparable anatomical and functional success rates at the 6th month follow-up. However, combining CsA with punctoplasty enhances both anatomical and functional success rates.