March 04, 2011
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Punctal occlusion with heat-energy-releasing cautery device may improve dry eye after plug extrusion

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For patients with dry eye who experience recurrent punctal plug extrusion, punctal occlusion surgery with a high heat-energy-releasing cautery device may be associated with a low recanalization rate, improved tear volume and better visual acuity, a study found.

The prospective, interventional case series consisted of 70 puncta from 44 eyes of 28 dry eye patients with aqueous tear deficiency and a history of recurrent punctal plug extrusion. Surgery was performed using the thermal cautery device Optemp II V (Alcon Japan).

The mean symptom score decreased from 3.9 ± 0.23 preop to 0.56 ± 0.84 at 3 months postop (P < .0001), while best corrected visual acuity improved from 0.11 ± 0.30 to 0.013 ± 0.22 (P = .003). Significant improvements in fluorescein staining score, rose bengal staining score, tear film break-up time and Schirmer test value were also observed, and only one puncta recanalized after surgery.

According to the study authors, the efficacy of this surgical procedure may result from instantly attaining and then maintaining a high temperature of 105ºC at the tip of the device and applying gentle pressure to the walls of the lacrimal punctum and canaliculus until the punctal tissue turns white.