1
|
Ranjan A, Basu S, Singh S. Punctal cautery in dry eye disease: A systematic review. Ocul Surf 2024; 34:235-240. [PMID: 39127391 DOI: 10.1016/j.jtos.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/23/2024] [Accepted: 08/07/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE To critically appraise the evidence on the efficacy and recanalization rates of permanent punctal occlusion via thermal or surgical means in managing dry eye disease (DED). METHODS In PubMed, Scopus, and Cochrane databases, two authors systematically reviewed the literature for prospective studies on punctal cautery or surgical occlusion (excluding punctal plugs) for DED. The studied outcomes were changes in tear volume, tear film stability, punctal recanalization rates, and patient symptomatology. RESULTS Nine studies (all single-arm) had 150 subjects (96 females). Five studies were on thermal punctal cauterization, and four used surgical occlusion techniques. One hundred eighty puncta were operated for eyes not responding to maximal lubricants or recurrent plug extrusion. DED etiologies were Sjogren's syndrome (78), cicatricial ADDE (27), graft-versus-host disease (12), and non-SS DED (50). Follow-up ranged from 3 to 24 months. At the final follow-up, improvements in Schirmer I and TBUT were 2.5 mm and 0.8s with thermal and 2.1 mm and 0.6s with surgical methods, respectively (P = 0.17 for Schirmer, P = 0.18 for TBUT). Punctal recanalization rates varied between thermal (0-38.7 %) and surgical (5-9%) techniques (p = 0.22). Different cautery devices show different recanalization rates; disposable thermal cautery tips directly inserted into the punctum had lesser recanalization than radiofrequency monopolar cautery. Most patients reported subjective improvement following the procedure, but no quantification measure was given in the studies. None of the published studies had a comparison group for performing a meta-analysis. CONCLUSION Based on non-comparative studies, thermal or surgical punctal occlusion improves tear volume in DED with similar recanalization rates; however, randomized controlled trials are needed to ascertain the real effects of punctal cautery on DED.
Collapse
Affiliation(s)
- Ashish Ranjan
- Hariram Motumal Nasta and Renu Hariram Nasta Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayan Basu
- Prof. Brien Holden Eye Research Centre (BHERC), LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swati Singh
- Hariram Motumal Nasta and Renu Hariram Nasta Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, Telangana, India; Prof. Brien Holden Eye Research Centre (BHERC), LV Prasad Eye Institute, Hyderabad, Telangana, India.
| |
Collapse
|
2
|
Gjukaj D, Dacheva I, Hildebrand GD. A Simple Step-by-Step Guide to Permanent Punctal Occlusion with the Ophthalmic Burr and Suture Technique. Klin Monbl Augenheilkd 2023; 240:1179-1184. [PMID: 37871593 DOI: 10.1055/a-2179-4498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
The medical treatment of dry eye disease usually follows a step-wise approach to achieve clinical improvement, ranging from non-surgical interventions with intensive lubrication to permanent surgical punctal occlusion. While frequent lubrication is essential, the intense regime is often too burdensome and difficult to maintain at the required frequency. Punctal plugs are an invaluable alternative approach, but also have limitations, especially in conscious children, in whom inserting and re-inserting punctum plugs in clinic can be challenging. If a patient has permanent and severe dry eye disease and responded well to a trial of temporary punctal plugging, a permanent surgical solution should be considered next. Liu et al showed that a more successful, yet simple technique to achieve permanent occlusion is to combine de-epithelialising the punctum and ampulla with the immediate firm apposition of the de-epithelialised surface using a self-absorbable suture - with a success rate of 92% in a prospective study. This article demonstrates this technique step-by-step in an 8-year-old child with severe chronic dry eye disease following proton beam therapy for orbital rhabdomyosarcoma. She underwent this procedure with excellent results.
Collapse
Affiliation(s)
- Driton Gjukaj
- Department of Ophthalmology, Cantonal Hospital St. Gallen, Switzerland
| | - Ivanka Dacheva
- Department of Ophthalmology, Cantonal Hospital St. Gallen, Switzerland
| | | |
Collapse
|
3
|
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. [PMID: 32467449 PMCID: PMC7704919 DOI: 10.1097/ico.0000000000002384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the long-term outcomes of surgical occlusion of lacrimal puncta using thermal cautery in the management of ocular surface diseases. METHODS We reviewed medical records of 80 consecutive patients from a single academic center who underwent punctal cauterization. Patient demographics, ocular history, symptoms, and signs of ocular surface diseases pre- and post-cauterization were recorded. RESULTS A total of 80 patients (171 puncta) were included, with an average age of 59 years and a follow-up duration of 27 months. The most common ocular morbidity was ocular graft-versus-host disease (n = 36), followed by primary keratoconjunctivitis sicca (n = 15). Indications for punctal cauterization included plug loss (n = 51), difficulty in plug fitting (n = 11), plug-related complications (n = 6), recanalization of previous cauterization (n = 7), and severe ocular surface disease requiring permanent punctal closure (n = 4). After punctal cauterization, the percentage of eyes with severe (21%) and moderate (25%) dry eye decreased significantly (8% and 19% at 3 months and 6% and 17% at 12 months, P = 0.0006). Fifty-four percent of patients reported improvement in their symptoms. The rate of recanalization was 21% during the follow-up period. The use of topical corticosteroids was associated with higher recanalization rate. Associated complications were limited to temporary pain and swelling. CONCLUSIONS Punctal cauterization is an effective modality in treating severe ocular surface diseases in patients who repeatedly lose punctal plugs, and it can be easily performed in a clinic setting without major complications. However, cauterization may need to be repeated in up to a quarter of cases because of recanalization.
Collapse
Affiliation(s)
- Yvonne Wang
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
| | | | - Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
| | - Reza Dana
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
| | - Jia Yin
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
| |
Collapse
|
4
|
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. [PMID: 29563770 PMCID: PMC5846759 DOI: 10.2147/opth.s155209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Surgical punctal occlusion is indispensable for the treatment of severe dry eye in cases where punctal-plug insertion is not applicable due to an enlarged or deformed punctum. However, permanent punctal occlusion is difficult in some cases. In our aim to establish a more reliable punctal occlusion, we have devised a new surgical approach for punctal occlusion. Patients and methods This study involved 20 puncta of 12 eyes of 12 patients (1 male and 11 females; mean age: 65.2 years) with severe aqueous-tear-deficient dry eye. A new surgical procedure for punctal occlusion using fibrous tissue from under the lacrimal caruncle into the diathermy-induced deepithelialized canaliculus as supporting tissue for punctal closure was performed. In all patients, the assessment of eye symptoms, as well as the condition of punctal occlusion by slit-lamp biomicroscopy, tear volume (tear-meniscus radius [TMR] measurement by meniscometry), the condition of precorneal tear film (graded by interferometry [IG]), measurement of fluorescein breakup time (FBUT), and scoring of ocular surface staining (fluorescein score of area [FSA] and density [FSD], and lissamine green score [LGS]) were performed, and the preoperative and 6-month-postoperative values were compared. Results In regard to the postoperative improvement of symptoms, 11 patients showed remarkable improvement, 1 patient showed improvement, and no reopening of the closed punctum was found in any patient. Test values were all significantly improved post surgery (all: P<0.05) as compared to those prior to surgery (respective values [mean ± SD], and the pre- and postoperative P-values were: TMR (mm) [0.18±0.08; 0.56±0.28, P=0.002], IG [4.3±0.9; 2.7±0.8, P=0.009], FBUT [0.4±0.6; 4.1±2.9, P=0.004], FSA [1.6±0.7; 0.7±0.9, P=0.03], FSD [2.7±0.7; 0.6±0.7, P=0.003], and LGS [5.1±2.7; 1.1±2.1, P=0.005]). Moreover, no postoperative complications were observed. Conclusion The findings of this study showed that our novel surgical procedure for punctal occlusion is highly successful and that it results in improved and more complete punctal occlusion.
Collapse
Affiliation(s)
- Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Aoi Komuro
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
5
|
Jones L, Downie LE, Korb D, Benitez-del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf 2017; 15:575-628. [DOI: 10.1016/j.jtos.2017.05.006] [Citation(s) in RCA: 578] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
|
6
|
|
7
|
Borrelli M, Geerling G. Current concepts of ocular adnexal surgery. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2013; 2:Doc06. [PMID: 26504698 PMCID: PMC4582485 DOI: 10.3205/iprs000026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ophthalmic Plastic and Reconstructive Surgery is a specialized area of ophthalmology that deals with the management of deformities and abnormalities of the eyelids, lacrimal system and the orbit. An ophthalmoplastic surgeon is able to identify and correct abnormalities of the ocular adnexae such as ectropion, lid retraction, conjunctival scarring with severe entropion, that can cause secondary ocular surface disorders; manage patients with watering eye, and when needed intervene with a dacryocystorhinostomy by external or endonasal approach and moreover minimize disfigurement following enucleation or evisceration and prevent further corneal damage, alleviate complains of tearing and grittiness, but also cosmetic complaints in patients with Graves' orbitopathy. Aim of this manuscript was to review current established and recently evolving surgical procedures.
Collapse
Affiliation(s)
- Maria Borrelli
- Department of Ophthalmology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gerd Geerling
- Department of Ophthalmology, Heinrich-Heine-University, Düsseldorf, Germany
| |
Collapse
|
8
|
Kakizaki H, Takahashi Y, Iwaki M, Nakano T, Asamoto K, Ikeda H, Goto E, Selva D, Leibovitch I. Punctal and canalicular anatomy: implications for canalicular occlusion in severe dry eye. Am J Ophthalmol 2012; 153:229-237.e1. [PMID: 21982102 DOI: 10.1016/j.ajo.2011.07.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 07/13/2011] [Accepted: 07/13/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize the microscopic anatomy of the lacrimal punctum and canaliculi in relation to the tarsal plate, muscle of Riolan, and Horner muscle; and to report a novel technique to excise the horizontal canaliculus in severe dry eye patients. DESIGN Observational anatomic study and a retrospective case series. METHODS The microscopic anatomy was studied in 86 eyelids of 25 cadavers (age range: 45-96 years, mean: 79.5 years). Surgery was performed on 18 canaliculi of 7 patients with dry eyes (age range: 37-69 years, mean: 59.9 years). In the microscopic study, 32 eyelids were incised sagittally, 38 eyelids were incised horizontally (1 mm from the eyelid margin), and 16 eyelids were incised parallel to the tarsal plate. All specimens were stained with Masson trichrome. In the surgical group, probe-guided horizontal canalicular excision with incision of the Horner muscle to the lateral edge of the lacrimal caruncle was performed. Both canalicular stumps were cauterized. RESULTS In the microscopic anatomic study, the punctum and the vertical canaliculus were part of the tarsal plate with the muscle of Riolan, whereas the horizontal canaliculus was surrounded by the Horner muscle. In the surgical group, all the operated canaliculi were completely occluded without recanalization 12 months postoperatively. No complications were recorded. CONCLUSIONS Based on microscopic anatomic findings that the lacrimal punctum and the vertical canaliculus are part of the tarsal plate, and that the horizontal canaliculus is surrounded by the Horner muscle, excision of the horizontal canaliculus may be an effective technique to treat patients with severe dry eyes.
Collapse
Affiliation(s)
- Hirohiko Kakizaki
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Anatomy of the Vertical Lacrimal Canaliculus and Lacrimal Punctum: A Macroscopic Study. Ophthalmic Plast Reconstr Surg 2011; 27:384-6. [DOI: 10.1097/iop.0b013e318219a54b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Abstract
Impairment of the peripheral or central part of the facial nerve causes an ipsilateral peripheral facial nerve paresis. It is quite a common syndrome and affects 20-35 persons per 100,000 per year in Western Europe and the United States. A possible complication of facial palsy is paralytic lagophthalmos with aesthetic and functional impairment for the patient. Beside primary nerve reconstructive procedures plastic-reconstructive procedures play a major role in correcting paralytic lagophthalmos. The eyebrow, upper and lower lids, medial and lateral lid angle as well as the lacrimal system need to be seen as functional units and can be corrected with local surgical procedures. Restoration of eye closure is the most important goal in treating the affected eye. Due to the significant aesthetic limitations and resultant psychological stress for the patient cosmetic aspects must be included in the surgical concept.
Collapse
Affiliation(s)
- T Schrom
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Plastische Operationen, HELIOS Klinikum Bad Saarow, Pieskower Str. 33, 15526, Bad Saarow.
| | | |
Collapse
|
11
|
Abstract
ABSTRACT Corneal ulcers can cause significant loss of vision from scarring and astigmatism, but rapid management can limit the destruction and improve outcomes. Infectious ulcers usually resolve with antimicrobial treatment. Noninfectious ulcers, however, present a diagnostic and therapeutic challenge. They can often be resolved by eliminating toxic medications and providing surface support with lubrication and collagenase inhibitors, but resistant ulcers may need more aggressive therapy with bandage contact lenses, tarsorrhaphy, or autologous serum. Ulcers impending perforation require urgent surgical management (e.g., tissue glue, conjunctival flaps, or keratoplasty). Topical steroids are useful when the ulceration is secondary to inflammatory mediators, but they are contraindicated in corneal melts with minimal inflammation, such as those associated with Sjogren syndrome. Systemic immunomodulation is required in addition to topical therapy in the presence of autoimmune disease. Understanding of the pathological processes that occur in different types of corneal ulcers is essential to formulation of a logical and effective treatment plan. Newer, more targeted treatment modalities may offer treatment options that have greater efficacy and fewer adverse effects.
Collapse
Affiliation(s)
- Sonal S Tuli
- Department of Ophthalmology and the Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL USA.
| | | | | |
Collapse
|
12
|
DeMartelaere SL, Blaydon SM, Tovilla-Canales JL, Shore JW. A Permanent and Reversible Procedure to Block Tear Drainage for the Treatment of Dry Eye. Ophthalmic Plast Reconstr Surg 2006; 22:352-5. [PMID: 16985418 DOI: 10.1097/01.iop.0000231773.20993.79] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a technique of canalicular ligation and report observations on 59 consecutive surgeries. METHODS Retrospective, non-comparative case series of canalicular ligation by 3 surgeons over a 7-year period. RESULTS Fifty-nine eyelids of 29 patients (2 men and 27 women) underwent canalicular ligation for the treatment of severe dry eyes. Patient age ranged from 34 to 90 years. Average length of follow-up was 20 months. There were no complications. Ninety-one percent of patients noted an improvement in their symptoms. Two patients developed symptomatic epiphora more than 1 year postoperatively and both underwent successful reversal. CONCLUSIONS Canalicular ligation is an effective technique for punctal occlusion in patients with severe dry eyes. It combines surgical ease with excellent cosmetic outcomes.
Collapse
|
13
|
Hepsen IF, Yildirim Z, Yilmaz H, Kotuk M. Preventive effect of lacrimal occlusion on topical timolol-induced bronchoconstriction in asthmatics. Clin Exp Ophthalmol 2005; 32:597-602. [PMID: 15575830 DOI: 10.1111/j.1442-9071.2004.00909.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the potential preventive role of lacrimal occlusion on the topical timolol-induced bronchoconstriction in asthmatics. METHODS This was a prospective and single-masked study. Fourteen volunteer subjects with asthma were included. Collagen plugs were inserted into both canaliculi on one side to inhibit lacrimal drainage. The effect of lacrimal occlusion on lung function tests was measured before and 60 min after the instillation of a timolol drop in unplugged and plugged eyes. The spirometric measurements include forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, and mid expiratory flow-rate (FEF25-75). RESULTS The timolol (0.5%) drop administration into the eye caused a significant decrease in pulmonary functions in patients with asthma in whom the lacrimal punctae had not been occluded by collagen plug. P values were 0.008 for FVC and 0.001 for FEV1 and FEF25-75. The occlusion of the lacrimal duct by intracanalicular plugs significantly reduced this decrease in pulmonary function. P values were 0.6 for FVC, 0.8 for FEV1, and 0.5 for FEF25-75. The lacrimal occlusion did not affect heart rate and blood pressures. Three subjects complained of epiphora. CONCLUSIONS Lacrimal occlusion with intracanalicular collagen plugs may almost completely prevent the bronchoconstriction caused by topical timolol in asthmatics by inhibiting or decreasing systemic absorption of the medication.
Collapse
Affiliation(s)
- Ibrahim F Hepsen
- Department of Ophthalmology, Turgut Ozal Medical Center, Inonu Univeristy, Malayta, Turkey.
| | | | | | | |
Collapse
|
14
|
|
15
|
Abstract
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.
Collapse
Affiliation(s)
- D Liu
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, USA.
| | | |
Collapse
|
16
|
Abstract
PURPOSE To evaluate the clinical efficacy and safety of silicone punctal plugs in various ocular surface disorders. PATIENTS AND METHODS Medical records of patients who underwent silicone punctal plug insertion from January 1996 to November 2000 were retrospectively reviewed. The clinical data collected included sex and age of the patients, indications for plug insertion, symptoms, corneal fluorescein staining and frequency of lubricant use at baseline and at 4 +/- 2 weeks after the insertion, location (upper versus lower punctum), initial versus replacement plug, spontaneous extrusion or removal of the plug, and percentage of complications and punctum cauterization. RESULTS There were 203 eyes of 153 patients (126 women and 27 men) in the study group. The total number of silicone punctal plug procedures was 312. Dry eye syndrome was the most common indication for punctal plug treatment (127 eyes, 62.5%), followed by epitheliopathy after penetrating keratoplasty (32 eyes, 15.8%). The symptoms improved in 150 (73.9%) of 203 eyes at 4 +/- 2 weeks' follow-up. The mean score of the fluorescein staining of the cornea was reduced from 2.7 +/- 0.1 to 1.3 +/- 0.1 with silicone punctal plug treatment at 4 +/- 2 weeks' follow-up. This reduction was statistically significant (p< 0.01). The overall success rate at 4 +/- 2 weeks follow up was 76.8%. The frequency of the lubricant use was significantly decreased with punctal plug treatment (p< 0.001). Considering all plugs, the estimated probability of plug retention was 49.4% with 85.1 +/- 7.3 weeks as the mean survival time. There was no statistical difference in plug retention rates between lower (49.6%) and upper (48.7%) plugs (p= 0.15). Retention rate of first plugs (53.5%) was significantly higher than that of second plugs (32.0%) (p= 0.05). The spontaneous total extrusion of silicone punctal plug was the most common complication in our study (158 plugs, 50.7%). The plug was removed in 14 eyes (14 plugs, 6.9%) because of epiphora in 11 eyes and conjunctival erosion in three eyes. The percentage of punctum cauterization performed in our population was 10.8%. CONCLUSIONS Punctal plug insertion is a simple, effective, safe, and reversible method to treat aqueous tear deficiency and other ocular surface diseases, such as epitheliopathy after penetrating keratoplasty, superior limbic keratoconjunctivitis, neurotrophic keratitis, recurrent corneal erosions, and toxic epitheliopathy not controlled by lubrication with preservative-free tears. However, spontaneous extrusion of silicone plug occurs commonly. Careful choosing of the optimal plug size and close follow-up are recommended to ensure the success of the treatment.
Collapse
Affiliation(s)
- Ming-Cheng Tai
- Cornea Service, Wills Eye Hospital, Department of Ophthalmology, Jefferson Medical College, Thomas Jefferson University, 900 Walnut Street, Philadelphia, PA 19107, U.S.A
| | | | | | | | | |
Collapse
|
17
|
Ozkan Y, Bozkurt B, Gedik S, Irkeç M, Orhan M. Corneal topographical study of the effect of lacrimal punctum occlusion on corneal surface regularity in dry eye patients. Eur J Ophthalmol 2001; 11:116-9. [PMID: 11456010 DOI: 10.1177/112067210101100202] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare topographic indices of surface regularity in dry eye patients and in normal subjects (controls) and to investigate the short-term effect of lacrimal punctal plugs on these indices in dry eye patients. METHODS The surface regularity index (SRI) and surface asymmetry index (SAI) of the TMS-2 corneal topographic modelling system were used to evaluate corneal surface regularity in 20 eyes of 10 dry eye patients before and after the insertion of Herrick silicon lacrimal plugs (Lacrimedics, Rialto, CA, USA) and in 24 eyes of 12 normal subjects as controls. RESULTS SRI and SAI were significantly lower in controls than dry eye patients (p=0.00). Median SRI was 1.72 in dry eye patients before punctal occlusion and 0.525 in the control group. Median SAI was 1.305 in dry eye patients and 0.240 in controls. After lacrimal punctal occlusion, Schirmer test results and fluorescein breakup time increased in nine patients and remained the same in one patient. After occlusion, the SRI decreased in 9 eyes, and increased in 11 (p=0.970); SAI decreased in 13 eyes and increased in 7 (p=0.135). CONCLUSIONS No significant change in topographic indices of corneal surface irregularity could be detected in severe dry eye patients with lacrimal punctal plugs in the short-term follow-up.
Collapse
Affiliation(s)
- Y Ozkan
- Department of Ophthalmology, Hacettepe University Hospital, Ankara, Turkey
| | | | | | | | | |
Collapse
|
18
|
McKinney P, Byun M. The value of tear film breakup and Schirmer's tests in preoperative blepharoplasty evaluation. Plast Reconstr Surg 1999; 104:566-9; discussion 570-3. [PMID: 10654706 DOI: 10.1097/00006534-199908000-00045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors published their article on the value of tear film breakup and Schirmer's tests in preoperative blepharoplasty evaluation in 1989. The purpose of this update is to expand the original article in light of refinements and experiences in subsequent years. It was concluded in the 1989 article that the abnormal tear film breakup and Schirmer's tests were not good predictors of possible postblepharoplasty dry eye complications. It was concluded in the review that the anatomy and the history including scleral show, lagophtholmus, negative vector, snap test, previous surgery, increased blinking, dryness, grittiness and pain were more important predictors of postoperative dry eye problems than the ocular tests. The authors' opinion remains so, and they do less preoperative tear film testing and place more emphasis on the history and the anatomy as predictors of potential problems. In this follow-up to the 1989 article, the authors include a survey from several surgeons as to how they evaluate their patients for elective aesthetic blepharoplasty, which in large measure confirms the authors' practice.
Collapse
Affiliation(s)
- P McKinney
- Division of Plastic and Reconstructive Surgery at Northwestern University Medical School, Chicago, Ill., USA
| | | |
Collapse
|
19
|
|
20
|
Soparkar CN, Patrinely JR, Hunts J, Linberg JV, Kersten RC, Anderson R. The perils of permanent punctal plugs. Am J Ophthalmol 1997; 123:120-1. [PMID: 9186107 DOI: 10.1016/s0002-9394(14)71002-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe previously unreported complications associated with permanent lacrimal punctal plugs. METHOD Five oculoplastic practices reviewed patients referred to them over the preceding 2 years for permanent lacrimal punctal plug complications. RESULTS In 12 patients, 14 lacrimal punctal plugs migrated distally within the lacrimal drainage system, causing symptoms and necessitating surgical removal. CONCLUSION Luxation of permanent punctal plugs into the distal lacrimal drainage system can occur, sometimes requiring complex surgical intervention.
Collapse
Affiliation(s)
- C N Soparkar
- Department of Ophthalmology, University of Massachusetts Medical Center, Worcester 01655-0322, USA
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
PURPOSE Significant epiphora occasionally develops after therapeutic punctal occlusion. When this complication occurs from combined scarring of the upper and lower proximal canaliculi, correction usually requires a conjunctivodacryocystorhinostomy. METHODS The authors describe a new microsurgical technique for reversing iatrogenic occlusion of both the upper and lower canaliculi. The relatively straightforward reconstruction uses the remaining canalicular system to create new tear outflow sites. RESULTS This procedure has been used successfully to repair eight of nine consecutive cases of iatrogenic canalicular occlusion, with an average follow-up of 2 years. CONCLUSION Iatrogenic canalicular occlusion can be reversed microsurgically without a conjunctivodacryocystorhinostomy.
Collapse
Affiliation(s)
- D V Pratt
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030, USA
| | | |
Collapse
|
22
|
Aritürk N, Oge I, Erkan D, Süllü Y, Sahin M. The effects of nasolacrimal canal blockage on topical medications for glaucoma. ACTA OPHTHALMOLOGICA SCANDINAVICA 1996; 74:411-3. [PMID: 8883562 DOI: 10.1111/j.1600-0420.1996.tb00720.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Twenty patients with primary open angle glaucoma who have been treated with identical antiglaucoma eye drops in both eyes were examined. Silicone punctal plugs were used to occlude the inferior punctum of one eye, in order to block the nasolacrimal canal. The intraocular pressures and effects of the medical therapy before and after punctal occlusion were compared. Punctal occlusion significantly decreased the intraocular pressure with an average of 2.00 +/- 0.43 mmHg in the plugged eyes (p < 0.001). The intraocular pressure in the unplugged control eyes did not change significantly (p > 0.05) after punctal occlusion of the fellow treated eye.
Collapse
Affiliation(s)
- N Aritürk
- Department of Ophthalmology, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
| | | | | | | | | |
Collapse
|
23
|
Abstract
Occlusion of the lacrimal canaliculi improves the objective signs and subjective symptoms of dry eye. In this review, methods of occlusion are classified as surgical, thermal and tamponade. Surgical methods include dacryocystectomy, canalicular ligature, canalicular offset, canalicular excision, transfer of the punctum to dry dock, punctal tarsorrhaphy and punctal patch. Thermal methods include cautery, diathermy and laser burn. Tamponade methods use absorbable inserts of hydroxypropyl cellulose, gelatin, collagen and catgut, and nonabsorbable inserts of silicone (punctum plugs, canalicular plugs), polyethylene, cyanoacrylate, and others. The characteristics of all these methods are analyzed.
Collapse
Affiliation(s)
- J Murube
- Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | | |
Collapse
|
24
|
Diamond JP, Morgan JE, Virjee J, Easty DL. Cannalicular occlusion with cyanoacrylate adhesive: a new treatment for the dry eye. Eye (Lond) 1995; 9 ( Pt 1):126-9. [PMID: 7713241 DOI: 10.1038/eye.1995.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
One hundred microlitres (0.1 ml) of N-butyl cyano-acrylate adhesive was injected into the inferior cannaliculus of 8 patients with dry eye. The adhesive induced total (upper and lower) cannalicular occlusion in each patient which has not resolved to date (mean follow-up 15.2 months, range 11-19 months). Complications were minor and not specific to use of this adhesive. It is hoped that its ultimate reversibility will make the technique suitable for younger patients with dry eye.
Collapse
Affiliation(s)
- J P Diamond
- University of Bristol, Department of Ophthalmology, Bristol Eye Hospital, UK
| | | | | | | |
Collapse
|
25
|
A Prospective, Randomized Comparison of Thermal Cautery and Argon Laser for Permanent Punctal Occlusion: Reply. Am J Ophthalmol 1994. [DOI: 10.1016/s0002-9394(14)73165-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
26
|
Vrabec MP, Elsing SH, Aitken PA. A prospective, randomized comparison of thermal cautery and argon laser for permanent punctal occlusion. Am J Ophthalmol 1993; 116:469-71. [PMID: 8213977 DOI: 10.1016/s0002-9394(14)71406-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Permanent punctal occlusion was performed by two techniques on 27 patients (73 puncta). Patients were randomly assigned to be treated with either thermal cautery or argon laser for keratitis sicca. Follow-up assessment disclosed that the puncta to which thermal cautery was applied remained closed significantly longer than those to which laser treatment was applied (P < .05, log-rank test). Using time to recanalization of a punctum as the end point, we found a long-term advantage of thermal cautery over argon laser treatment.
Collapse
Affiliation(s)
- M P Vrabec
- Department of Surgery, University of Vermont College of Medicine, Burlington
| | | | | |
Collapse
|
27
|
|
28
|
Glatt HJ. Failure of Collagen Plugs to Predict Epiphora After Permanent Punctal Occlusion. Ophthalmic Surg Lasers Imaging Retina 1992. [DOI: 10.3928/1542-8877-19920401-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
29
|
Snow SN, Zweibel S, Lo JS. Rapid atraumatic nail plate removal using the cordless cautery unit. THE JOURNAL OF DERMATOLOGIC SURGERY AND ONCOLOGY 1992; 18:322-6. [PMID: 1560157 DOI: 10.1111/j.1524-4725.1992.tb03678.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article describes the use of a handy, battery-powered, thermocautery unit to cut through the nail plate when performing dermatologic surgery involving nail tissue. Thermocauterization of keratin is a simple, atraumatic method of removing portions of the nail plate, so that the underlying soft tissue may be biopsied or treated. The units are inexpensive and safe to operate.
Collapse
Affiliation(s)
- S N Snow
- Department of Surgery, University of Wisconsin, Mohs Surgery Clinic, Madison 53705
| | | | | |
Collapse
|
30
|
Girard LJ, Barnett L, Rao R. A simple, inexpensive technique for punctal occlusion. Am J Ophthalmol 1992; 113:340-1. [PMID: 1543235 DOI: 10.1016/s0002-9394(14)71594-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
31
|
|