Tarsorrhaphy and lacrimal occlusion

Corneal hydration and protection can be achieved through increased lubrication or decreased evaporation. Hence, an important therapeutic strategy to corneal desiccation involves occlusion of the lacrimal drainage system in order to decrease tear outflow and provide additional ocular surface hydration. Three general approaches can be used: temporary, reversible, or permanent occlusion of the lacrimal drainage system. Often, the treatment approach follows the same progression: temporary occlusion is tested using absorbable punctal plugs. If symptomatic relief and objective improvement are achieved, reversible long-term occlusion is attempted with a nonabsorbable device. In situations where lacrimal outflow occlusion achieves symptomatic resolution but requires frequent replacement or causes ocular irritation, permanent surgical occlusion using a punctoor canaliculodestructive procedure may be cautiously considered.