Punctal Occlusion for the Dry Eye

Treatment of dry eye by blocking the lacrimal canaliculi

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.

Cannalicular occlusion with cyanoacrylate adhesive: a new treatment for the dry eye

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.