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Punctal Plugs and Cautery



Punctal occlusion for dry eye is performed when the tear volume is low and works by reducing drainage of the tears down into the nose and then to the throat. This can be achieved either by inserting a carefully measured medical grade silicone implant into the punctal opening of either the lower or sometimes the upper eyelid.

It is also possible to cause the same effect by inserting an implant further down the drainage system, in which case its termed an intra-canalicular implant, or by inducing surgical shrinkage of the punctal opening by thermal or radio-frequency cautery. Examples of these procedures are shown in our punctal occlusion video.

There are a number of reasons why punctal plugs have become the most popular method of treating dry eye. They have a very high rate of success; and the optometrist can insert them easily and painlessly. They are also reversible if too much tearing is produced.They can be easily removed if no longer required. Plugs are usually effective for at least 2-3 years. Punctal plugs often enable a patient who would otherwise have to give up wearing contact lenses, to keep doing so.


Some people have a puncta that is too large or lax to hold a punctal implant - in these cases we often consider punctal cautery as an option. This procedure sounds worse than it really is. The punctal opening is strongly numbed with anesthetic beforehand and the thermal or radio-frequency tip is only in contact with the lid tissue for a second or so. Cautery is a more permanent form of occlusion in most cases and so can work out cheaper in the long run than having punctal plugs fitted as these may need replacing as the punctal opening enlarges as the tissues age.

Dry eye patients should also consider the option of Intense pulsed light treatment, also known as IPL, which also increases tear volume, this time by reducing tear evaporation loss. IPL also reduces inflammation and restores the tear osmolarity (saltiness) which then further improves tear quality by improving the health of the mucous secreting conjunctival goblet cells.

Patients interested in having Amniotic Membranes or Punctal Implants fitted or IPL will need to have a specialist therapeutic dry eye evaluation first to ensure that they are the most appropriate option and whether other treatments are also required. Please phone or email our practices for an appointment.