Punctal Occlusion (Punctal Cautery)

Punctal Occlusion (Punctal Cautery)If you have dry eye syndrome, you’re not alone. Dry eye syndrome — a disorder of the eye’s tear film that causes it to decrease tear and moisture production — is one of the most common complaints that eye care professionals hear. Up to 20 percent of adults are diagnosed with dry eye syndrome during their lives.

Your tears are made up of a combination of water, fatty oils and mucus. This complex combination of elements keeps the surface of your eye smooth and moist. When your eye isn’t producing enough moisture, the surface becomes dried out and uncomfortable. It also can lead to infection, because your eye is not as able to repel bacteria when it is drier than it should be.

All symptoms, potential procedural/surgical options should always be discussed with your physician after a thorough consultation and examination  for an accurate diagnosis and treatment plan.

Punctal Plugs

Punctal plugs, or lacrimal plugs, are tiny biocompatible devices placed in your tear ducts (punctum) to block drainage during a procedure called punctal occlusion. This blockage helps keep your eyes moist by saving your tears and any artificial tears that you may be using. These plugs are removable when your condition improves.

There are two kinds of punctual plugs:

  1. Made of collagen, this one dissolves in less than a week.
  2. The other is made of silicone and remains in place until removed by your ophthalmologist.

Your doctor may attempt a punctal occlusion with a solution that has the least permanence first, to see if it benefits you. If it does, the more permanent version is installed. Your doctor has the option of using five different shapes of punctual plugs:

  1. Umbrella: These plugs are visible in the tear duct and easy to remove.
  2. Reservoir: These capture tears and hold them, increasing comfort and decreasing the irritation.
  3. Hollow: This shape helps the plugs stay in place, conforming to the shape of your tear duct.
  4. Tapered: This shape keeps the plug in place by exerting pressure horizontally.
  5. Slanted or low profile cap: These plugs provide extra stability and comfort.

Thermal Cautery

Your doctor can also use a more permanent solution called thermal cautery. This procedure uses heat to permanently block the tear ducts, forcing the tears you produce naturally and artificial tears to stay in your eye.

None of these solutions provide relief from the regimen of artificial tears, however. You need to use artificial tears indefinitely to supplement your own body’s tear production. These procedures assist your body in keeping your eyes sufficiently moist for comfort and prevention of infection.

Plug Installation

Prior to the procedure, your doctor measures the size and shape of your tear ducts using a special instrument. This helps determine which type to use, and where to place them for maximum benefit. Before the procedure, your doctor may use a local, topical anesthetic, but in many cases none is needed. The procedure, done in your doctor’s office, takes only minutes to complete with little to no discomfort.

Each of your eyes has two punctum, one on each eyelid. Plugs can be inserted in one or both. Your doctor may also use a special instrument to enlarge the punctum, making insertion easier. Most often, this procedure is quick and painless. After the process, you can go home to resume normal activities almost immediately.

Rare Complications

Rarely, a plug that has been inserted falls out or migrates outside the intended area, where it can be carried further down into the drainage channel of the eye. This can create blockages, swelling and pain. If this happens, contact your doctor right away to avoid further complications such as infection or damage. Flushing out the dislodged plug gives you immediate relief.

Another rare occurrence involves plugs that work too well, leading to a condition called epiphora. This condition causes too much tearing. You can get relief by just taking the plug out. Also rare is infection that’s easily treated with antibiotics.

Warning Signs

Talk to your ophthalmologist about your condition to receive the simple solution. The symptoms of dry eye to watch for include:

  • Usually affects both eyes
  • Blurred vision or eye fatigue
  • Light sensitivity
  • Stringy mucus in or around your eyes
  • Red eyes
  • Feeling of something in your eye
  • Watery eyes, which is the your body’s way of coping with dry eyes
  • Problems with driving at night
  • Difficulty wearing contact lenses

See your doctor if the symptoms listed above are present for a long period of time or if the irritation makes your eyes painful. Your ophthalmologist evaluates your situation to decide which course of treatment is best for your situation.

Risks Associated with Dry Eyes

There are a number of causes for this condition, which actually is quite common. A few reasons why you may have dry eyes include:

  • Aging
  • Medications including antihistamines, decongestants, hormone replacement therapy (HRT), blood pressure drugs, birth control and treatment for Parkinson’s disease
  • Laser eye surgery, although this is usually temporary and resolves over time
  • Tear gland damage due to radiation or inflammation

You could also have dry eyes because of increased tear evaporation. Causes of this are often environmental and can include:

  • Blinking less often: it happens while reading, driving or working at a computer
  • Eyelid problems such as out-turning lids (ectropion) or in-turning lids (entropion)
  • Wind, smoke or dry air

Another cause could be an imbalance in the composition of your tears. Any problems with the mixture of water, oil and mucus could lead to dry eye syndrome.


Dry eyes can lead to additional problems with your eyes. Without that smooth moist surface, your eyes become vulnerable to a number of issues, including:

  • Eye infections
  • Damage to the surface of your eye: abrasion of the corneal surface, corneal ulcer and vision problems caused by inflammation
  • Decreased quality of life, as it may become difficult to do everyday things such as reading

Most of the time, dry eyes can be treated with over-the-counter artificial tears (eye drops). Used regularly, they can relieve the symptoms of dry eye and prevent any complications. If the eye drops don’t help and your symptoms are more serious, you may require a punctal occlusion.

Sometimes, treatment can involve changing the conditions that cause your dry eyes. Other remedies can stop your tears from draining too quickly, or improve the quality of your tears. Additionally, treating an underlying health problem can relieve the symptoms of dry eye. If these solutions don’t produce the desired relief, then the simple surgical options may be best.

All symptoms, potential procedural/surgical options should always be discussed with your physician after a thorough consultation and examination  for an accurate diagnosis and treatment plan.

Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult eye doctor about your specific condition. Only a trained, experienced board certified eye doctor can determine an accurate diagnosis and proper treatment.

Do you have any questions about Punctal Occlusion (Cautery) or Punctal plugs, lacrimal plugs procedure in NYC? Would like to schedule an appointment with the top NYC Ophthalmologist, Optometrist Dr. Saba Khodadadian of Manhattan Eye Specialists, please contact our office for consultation with eye doctor.

Manhattan Eye Specialists
Dr. Saba Khodadadian, Optometrist (NYC Eye Doctor)

983 Park Avenue, Ste 1D19
New York, NY 10028

(Between Madison Ave & Park Ave)
(212) 533-4821

The information on this website is to provide general guidance. In no way does any of the information provided reflect definitive medical advice and self diagnoses should not be made based on information obtained online. It is important to consult a best in class Optometrist or Ophthalmologist in NYC regarding ANY and ALL symptoms or signs as it may a sign of a serious illness or condition. A thorough consultation and examination with an eye specialist should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call your local eye doctor or call our office today and schedule a consultation.