Purchase this article with an account.
BB Quiroz, JC Affeldt; Complications Associated with Deep Thermal Punctal Occlusion . Invest. Ophthalmol. Vis. Sci. 2002;43(13):67.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose:Despite the widespread and increasing popularity of nasolacrimal plugs, thermal (cautery) punctal occlusion remains the definitive therapy for certain advanced ocular conditions. A comprehensive review of cautery-related complications, however, has not been published, with current studies limited to case reports and description of recanalization rates only. The purpose of this study was to document the spectrum, incidence and intervention required for complications encountered in a large series of patients undergoing deep thermal punctal occlusion. Methods:All patients seen at the Inland Eye Institute between March 11, 1998 and August 18, 2001 with severe dry eye, neurotrophic keratitis or exposure, and experiencing treatment failure with topical lubricants as well as lacrimal plugs underwent thermal punctal occlusion. Depending upon clinical response, treatment was sequenced from the inferior to the superior lid, and consisted of deep punctal electrocautery applied under local anesthesia. Results:Sixty-four consecutive patients comprising 116 punctum underwent cautery occlusion. Mean follow-up time was 6.9 months. Complications included: localized punctal cellulitis, 1.7% successfully treated with topical antibiotics; localized entropion with trichiasis, 1.7% corrected with epilation; epiphora, 3.4% successfully treated with opposing canalicular plug flush (one case), punctal dilation/probe (one case), and spontaneous resolution (2 puncta/one patient); and recanalization 58% (67/116). Recanalization was nearly four times as common in the lower punctum as the upper. When recanalization was associated with clinical regression (34/67), retreatment was performed, with an average of 1.6 attempts required for permanent closure. The maximum number of retreatments applied was five. No patients in this study experienced local anesthesia related complications, conjunctivitis, canaliculitis, pyogenic granuloma, or dacryocystitis. Conclusion:Aside from recanalization, the overall spectrum and incidence of complications associated with deep thermal punctal occlusion was not only minimal, but appeared less than for permanent lacrimal or punctal plugs. Likewise, complications that were encountered were easily treated in a clinic setting without need for complex surgical intervention. Recanalization, however, was common and disproportionately involved the inferior punctum, with multiple retreatments potentially required to effect closure. Complete puntal closure, however, was ultimately required in only 50% of recanalized cases.
This PDF is available to Subscribers Only