CLINICAL SCIENCE Surgical punctal occlusion: a prospective study

Aims: To assess the outcome of a surgical punctal occlusion technique. Method: Prospectively, 11 consecutive patients (26 puncta) with severe dry eyes recalcitrant to maximal medical therapy underwent permanent punctal occlusion at a tertiary eye care centre between January 1999 and December 2000. The epithelium of the punctum and the vertical portion of the canaliculus was removed with a corneal rust ring burr. The bared punctum-canaliculus complex was closed with a 6-0 chromic suture. Success was measured by the complete functional occlusion of the punctum, tear function tests, and patients’ response. Result: Five males and nine females, aged 26–77 enrolled in the study with three patients later excluded. As of November 2001, the remaining 11 patients had follow up ranging from 14 to 34 months (mean 24 months; median 24 months). 24 puncta (or 92%) remained occluded, including four puncta which showed anatomical reopening. Seven out of 11 patients (63.6%) stated they had symptomatic improvement regardless of their objective findings. Conclusion: This technique resulted in a 92% permanent occlusion of the puncta and compared favourably with other reported techniques. Punctal occlusion does not appear to correlate well with Schirmer tests, the frequency of lubrication, and/or subjective feelings in these patients.