Punctal Cautery

Your doctor may recommend cauterizing your tear ducts to retain moisture in your eyes. Local anesthesia will be injected near the site of the cautery. The cautery procedure itself is very fast.

Some doctors prefer to cauterize deeply, ensuring that the tear duct will not reopen, whereas others prefer to perform a procedure which is not as deep, and can be easily reversed in the office.

After cautery, you will likely be prescribed an antibiotic ointment to prevent infection. You will be instructed not to touch the eye to prevent opening, or infecting, the cautery site.

Sometimes cautery sites reopen by themselves. If this happens, the site may be cauterized again.

After beginning treatment, if your corneal sensation returns or your lacrimal glands begin to function more normally, you may produce sufficient aqueous tears to open tear ducts that were previously cauterized. This is one reason why some doctors prefer to cauterize less deeply. It may take a few sessions to open your tear ducts sufficiently because some doctors are prudent about opening ducts, being careful not to open them too much, and recreating the aqueous deficiency that was once a cause of discomfort and other problems.

Your doctor will determine if it is time to open tear ducts that were cauterized based on symptoms, such as frequency of epiphora or even Schirmer  tests.

Although retaining tears through punctal cautery can exacerbate symptoms (such as burning and saponification) when there is poor quality meibum or other inflammatory co-morbidities, if aqueous deficiency continues to be a problem, than cauterizing, and not reopening the tear ducts too much, may be more important than drainage.


Reversal of iatrogenic punctal and canalicular occlusion
Pratt DV, Patrinely JR.
1996 Sep;103(9):1493-7.
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Surgical punctal occlusion with a high heat-energy releasing cautery device for severe dry eye with recurrent punctal plug extrusion
Ohba E, Dogru M, Hosaka E, Yamazaki A, Asaga R, Tatematsu Y, Ogawa Y, Tsubota K, Goto E.
American journal of ophthalmology
2011 Mar;151(3):483-7.e1. doi: 10.1016/j.ajo.2010.08.045. Epub 2011 Jan 12.
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Two-year outcome of partial lacrimal punctal occlusion in the management of dry eye related to Sjögren syndrome
Holzchuh R, Villa Albers MB, Osaki TH, Igami TZ, Santo RM, Kara-Jose N, Holzchuh N, Hida RY.
Current eye research
2011 Jun;36(6):507-12. doi: 10.3109/02713683.2011.569870.
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