[New surgical methods for punctal occlusion of severe tear-deficient dry eye and its outcome]

Although several surgical methods for punctal occlusion have been reported, it is difficult to obtain complete punctal occlusion in all cases since recanalization of the punctum often occurs after the operation. In this report, new surgical procedures to obtain sufficient occlusion of punctum are introduced and the outcome of the present method is compared with that of previous methods.

Subjects were 33 severe tear-deficient dry eye patients (4 males and 29 females; mean age: 54.3 yrs.) and they were considered as candidates for punctal occlusion of both upper and lower puncta. The previous surgical punctal occlusion method had been performed in 12 cases (group A: 10 females and 2 males) and the newly-developed method was applied to 21 cases (group B : 19 females and 2 males). Corneal epithelial damage(scored with AD classification; A : area, D : density, scored from 0 to 3) was compared before and after the treatment and the control-lability of dry eye with only an artificial tear preparation was compared between the previous and the new methods. The newly-developed surgical procedures include the following steps: (1) diathermy of the epithelium of the canaliculus using a newly-designed electric needle for diathermy, (2) full removal of the epithelium of the canaliculus using a hand motor drill, (3) cutting the punctum at two opposite points parallel to the lid margin, (4) suturing the punctum to close the cut punctum with 10-0 nylon or 8-0 absorbable sutures.

In group A, corneal epithelial damage improved a little from A, D : 2.4, 2.1 to A, D: 1.8, 1.9 during an average of 7.2 months of alone follow-up, and only 2 of the 12 cases obtained control with eye drops. In group B, the corneal epithelial damage improved significantly from A, D : 2.1, 2.2 to A, D : 1.0, 1.3 during an average of 8.2 months of follow-up, and all cases obtained control with eye drops alone.

The new surgical methods are regarded as a more complete way of performing surgical punctal occlusion compared to previous methods.