Surgical punctal occlusion with a high heat-energy releasing cautery device for severe dry eye with recurrent punctal plug extrusion

Am J Ophthalmol. 2011 Mar;151(3):483-7.e1. doi: 10.1016/j.ajo.2010.08.045. Epub 2011 Jan 12.

Abstract

Purpose: To report the rate of recanalization and the efficacy of punctal occlusion surgery with a high heat-energy-releasing cautery device in patients with severe dry eye disease and recurrent punctal plug extrusion.

Design: Prospective, interventional case series.

Methods: Seventy puncta from 44 eyes of 28 dry eye patients underwent punctal occlusion with thermal cautery. All patients had a history of recurrent punctal plug extrusion. A high heat-energy-releasing thermal cautery device (Optemp II V; Alcon Japan) was used for punctal occlusion surgery. Symptom scores, best-corrected visual acuity, fluorescein staining score, rose bengal staining score, tear film break-up time, and Schirmer test values were compared before and 3 months after the surgery. Rate of punctal recanalization also was examined.

Results: Three months after surgical cauterization, symptom score decreased from 3.9 ± 0.23 to 0.56 ± 0.84 (P < .0001). Logarithm of the minimal angle of resolution best-corrected visual acuity improved from 0.11 ± 0.30 to 0.013 ± 0.22 (P = .003). Fluorescein staining score, rose bengal staining score, tear film break-up time, and the Schirmer test value also improved significantly after the surgery. Only 1 of 70 puncta recanalized after thermal cauterization (1.4%).

Conclusions: Punctal occlusion with the high heat-energy-releasing cautery device not only was associated with a low recanalization rate, but also with improvements in ocular surface wetness and better visual acuity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cautery / instrumentation*
  • Dry Eye Syndromes / physiopathology
  • Dry Eye Syndromes / surgery*
  • Eyelids / surgery*
  • Female
  • Fluorophotometry
  • Humans
  • Lacrimal Apparatus / surgery*
  • Male
  • Prospective Studies
  • Prostheses and Implants*
  • Prosthesis Failure*
  • Tears / physiology
  • Visual Acuity / physiology