Preserve the reserve: The novel way

Abstract

Abstract Aims: To assess the outcome of a novel approach for thermal punctocanalicular cautery in severe dry eye patients. Materials and Methods: After tear function tests, eligible patients with severe dry eyes recalcitrant to maximal medical therapy underwent permanent punctocanalicular occlusion by thermal punctocanalicular cauterization at a tertiary eye hospital between January 2013 and February 2018. The epithelium of the punctum, the vertical portion and the horizontal portion of the canaliculus was cauterized with long hairline tip of Ellman thermal punctal cautery. Change in Schirmer’s 1, tear film breakup time (TBUT) and fluorescein staining of the corneal epithelium at last follow up were primary outcome measures. Results: Our study included 85 eyes of 47 patients with a mean age of 42.6 ± 17.6 years of which 31 (66%) were women. The average follow up was 68 ± 74 weeks and 85.88% of puncta remained occluded till last follow up. The Schirmer’s 1 improved from 3.2 ± 2.3 mm to 4.3 ± 2.1 mm (P < 0.001), the TBUT improved from 3.3 ± 1.6 s to 4.8 ± 1.5 s (P < 0.001) and average fluorescein stain score reduced from 14.08 ± 2.5 to 7.68 ± 1.71 (P < 0.001). The frequency of using lubricants also reduced significantly from 10 ± 3 times per day to 6.7 ± 2.1 times per day (P < 0.001). No postoperative complication in the form of epiphora or punctal cellulitis were observed. Conclusions: Thermal punctocanalicular cautery is a novel, simple, repeatable, noninvasive and highly effective method for severe dry eye cases. Majority patients showed permanent punctal canalicular occlusion with improvement in tear film function. Frequency of instillation of lubricants needed decreased which can indirectly reduce the economic burden for the patients.