Journal of Ophthalmic and Vision Research
ISSN: 2008-322X
The latest research in clinical ophthalmology and the science of vision.
Surgical Punctal Occlusion; Combined Lacrimal Canaliculi Cauterization and Punctal Suturing for Severe Dry Eye
Published date: Apr 19 2023
Journal Title: Journal of Ophthalmic and Vision Research
Issue title: April–June 2023, Volume 18, Issue 2
Pages: 143–149
Authors:
Abstract:
Purpose: To evaluate the treatment outcome of surgical punctal occlusion with combined canaliculi ablation and punctal suturing in patients with severe dry eye.
Methods: Eleven eyes of seven patients were diagnosed with severe dry eye with decreased lacrimal secretion and were refractory to treatment with various eye drops and/or had repeatedly experienced loss of punctal plugs, and continued to experience subjective symptoms received surgical punctal occlusion. In 20 puncta, lacrimal canaliculi ablation was performed along the entire length of the lacrimal canaliculus where a diathermy needle could be inserted. After resection of the annulus fibrosus in the peri-punctal area, tight cross-stitch suturing of the puncta was performed with 8-0 absorbent thread. Visual acuity, corneal staining score according to the area (A) and density (D) classification, and Schirmer tear test (STT); tear break up time (tBUT); and subjective symptoms assessed by the University of North Carolina (UNC) and Dry Eye Management Scale were compared before and one year after surgery.
Results: Recanalization occurred in 1/20 puncta (5.0% at month 5) in 1/11 eyes. Student’s t-test showed significant improvement at one year compared with preoperative values for LogMAR value (P = 0.019), corneal staining score A (P = 0.00003) and D (P = 0.0003), STT (P = 0.004), and subjective symptoms (P = 0.015). No change was shown in tBUT and no serious adverse event occurred.
Conclusion: This improved, minimally invasive surgical procedure has a low recanalization rate and achieves both objective and subjective improvements at one year.
Keywords: Cauterization; Dry Eye; Lacrimal Canaliculi; Lacrimal Puncta; Punctal Occlusion
Keywords: Cauterization, Dry Eye, Lacrimal Canaliculi, Lacrimal Puncta, Punctal Occlusion
References:
1. Tsubota K, Pflugfelder SC, Liu Z, Baudouin C, Kim HM, Messmer EM, et al. Defining dry eye from a clinical perspective. Int J Mol Sci 2020;21:9271.
2. Tsubota K, Yokoi N, Watanabe H, Dogru M, Kojima T, Yamada M, et al. Members of The Asia Dry Eye Society. A new perspective on dry eye classification: Proposal by the Asia Dry Eye Society. Eye Contact Lens 2020;46:S2– S13. 3. Clayton JA. Dry eye. N Engl J Med 2018;378:2212–2223.
4. Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, et al. TFOS DEWS II diagnostic methodology report. Ocul Surf 2017;15:539–574.
5. Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, et al. TFOS DEWS II management and therapy report. Ocul Surf 2017;15:575–628.
6. Ervin AM, Law A, Pucker AD. Punctal occlusion for dry eye syndrome. Cochrane Database Syst Rev 2017;6:CD006775.
7. Ervin AM, Law A, Pucker AD. Punctal occlusion for dry eye syndrome: Summary of a Cochrane systematic review. Br J Ophthalmol 2019;103:301–306.
8. Chen F, Wang J, Chen W, Shen M, Xu S, Lu F. Upper punctal occlusion versus lower punctal occlusion in dry eye. Invest Ophthalmol Vis Sci 2010;51:5571–5577.
9. Horwath-Winter J, Thaci A, Gruber A, Boldin I. Long-term retention rates and complications of silicone punctal plugs in dry eye. Am J Ophthalmol 2007;144:441–444.
10. Geerling G, Tost FH. Surgical occlusion of the lacrimal drainage system. Dev Ophthalmol 2008;41:213–229.
11. Liu D, Sadhan Y. Surgical punctal occlusion: A prospective study. Br J Ophthalmol 2002;86:1031–1034.
12. Shalaby O, Rivas L, Rivas AI, Oroza MA, Murube J. Comparison of 2 lacrimal punctal occlusion methods. Arch Soc Esp Oftalmol 2001;76:533–536.
13. Putterman AM. Canaliculectomy in the treatment of keratitis sicca. Ophthalmic Surg 1991;22:478–480.
14. Murube J, Murube E. Treatment of dry eye by blocking the lacrimal canaliculi. Surv Ophthalmol 1996;40:463–480.
15. Dohlman CH. Punctal occlusion in keratoconjunctivitis sicca. Ophthalmology 1978;85:1277–1281.
16. Wang Y, Carreno-Galeano JT, Singh RB, Dana R, Yin J. Long-term outcomes of punctal cauterization in the management of ocular surface diseases. Cornea 2021;40:168–171.
17. Benson DR, Hemmady PB, Snyder RW. Efficacy of laser punctal occlusion. Ophthalmology 1992;99:618–621.
18. Nelson CC, Reed S. Argon laser versus thermal cautery for punctal occlusion. An animal study. Ophthalmic Plast Reconstr Surg 1991;7:173–176.
19. Hutnik CM, Probst LE. Argon laser punctal therapy versus thermal cautery for the treatment of aqueous deficiency dry eye syndrome. Can J Ophthalmol 1998;33:365–372.
20. Knapp ME, Frueh BR, Nelson CC, Musch DC. A comparison of two methods of punctal occlusion. Am J Ophthalmol 1989;108:315–318.
21. Ohba E, Dogru M, Hosaka E, Yamazaki A, Asaga R, Tatematsu Y, et al. Surgical punctal occlusion with a high heat-energy releasing cautery device for severe dry eye with recurrent punctal plug extrusion. Am J Ophthalmol 2011;151:483–487.
22. Yokoi N, Komuro A, Sotozono C, Kinoshita S. A new surgical approach for punctal occlusion using fibrous tissue from under the lacrimal caruncle. Clin Ophthalmol 2018;12:463–472.
23. Yokoi N, Nishii M, Komuro A, Kinoshita S. New surgical methods for punctal occlusion of severe tear-deficient dry eye and its outcome. Nippon Ganka Gakkai Zasshi 2004;108:560–565.
24. Miyata K, Amano S, Sawa M, Nishida T. A novel grading method for superficial punctate keratopathy magnitude and its correlation with corneal epithelial permeability. Arch Ophthalmol 2003;121:1537–1539.
25. Grubbs J Jr, Huynh K, Tolleson-Rinehart S, Weaver MA, Williamson J, Lefebvre C, et al. Instrument development of the UNC Dry Eye Management Scale. Cornea 2014;33:1186–1192.
