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Punctal Occlusion

Punctal Plugs & Cautery

 

Dry Eye is caused by either a patient not secreting enough water into their tears, often a problem post menopause or associated with certain inflammatory conditions, or excess evaporation of the watery component of the tears often due blocked oily glands on the lid margin. Dry Eye management can take many forms from eye drops such as the TLC product MeiboTears, lid hygiene with products such as Theratears Sterilid, TLC Meiboclean and TLC sensitive Lid Wipes, Intense Pulsed Light Photo-biomodulation (IPL) and punctal occlusion either with punctal plugs or cautery

Punctal occlusion 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.



 


Diagram of the EAGLE-VISION Punctal Plug into the drainage system of the lower eyelid.

Eagle

More than 300,000 dry eye sufferers have been successfully treated, through punctal and canalicular occlusion.

These safe silicone medical grade implants are inserted into the larger, inferior opening of the tear drainage system, near the nose, thereby keeping about 65% of the tears that would have previously drained down the throat in contact with the eye. They can be easily removed if no longer required.

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 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. Plugs are usually effective for at least 2-3 years.

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.


 

see also:-

What causes dry eye?
Theratears
Dry Eye Symptoms in contact lens patients