Punctal Cautery for Tear Conservation in Cicatrizing Dry Eye: A Case Report

Abstract

Aqueous-deficient dry eye (ADDE) is a debilitating ocular surface disorder that significantly impairs patient quality of life. In severe cases, particularly those associated with cicatrizing conjunctival diseases, conventional medical therapy may be insufficient to restore ocular surface homeostasis. Therefore, tear conservation plays a critical role in management, and punctal cauterization offers a reliable method for permanent occlusion of the lacrimal drainage system, enhancing tear retention and stability. Compared with temporary measures, it provides a durable solution with sustained clinical benefit. Here, we report a case of ocular cicatricial conjunctivitis with severe ADDE that was refractory to maximal topical and systemic therapy, but showed marked improvement following punctal cauterization. Post-procedure, there was significant improvement in both subjective symptoms and objective parameters, including visual acuity, Schirmer’s test values, tear breakup time, and ocular surface staining. This case highlights the importance of punctal cautery as an effective and practical intervention in the management of severe, treatment-resistant ADDE.