Aqueous deficiency dry eye in post conjunctivitis cicatrization-Effect of deep thermal punctal cautery

Purpose: To evaluate the effect of deep thermal punctal cautery in eyes with post-conjunctivitis cicatrization. Methods: This retrospective study consisted of patients who underwent deep thermal punctal cautery for post-conjunctivitis dry eye (PCDE). The diagnosis was based on a history suggestive of viral conjunctivitis in past followed by the onset of present clinical features of aqueous deficiency dry eye (ATD). All patients underwent a rheumatological evaluation to rule out underlying systemic collagen vascular disease as a cause for dry eye. The extent of cicatricial changes was noted. Best-corrected visual acuity (BCVA), Schirmer's test, and fluorescein staining score (FSS; total score of 9) were analyzed pre-and post-cautery. Results: Out of 65 patients (117 eyes), 42 were males. The mean age at presentation was 25.769 +/- 12.03 years. Thirteen patients presented with unilateral dry eye. Pre-cautery BCVA (logarithm of the minimum angle of resolution [logMAR]) and Schirmer's test (mm) improved from 0.5251 +/- 0.662 to 0.372 +/- 0.595 (P value = 0.000, 95% confidence interval [CI]: 0.09-0.22), and 1.952 +/- 2.763 to 4.929 +/- 4.338 (P value = 0.000, 95% CI:-3.79-2.17); post-cautery, respectively. The pre-cautery FSS of 5.9 +/- 2.82 reduced to 1.58 +/- 2.38 (P value = 0.000, 95% CI: 3.46-5.17) post-cautery. The mean follow-up was 11.22 +/- 13.32 months. No progression in cicatricial changes was noted in any eye during the follow-up. Re-canalization rate was 10.64%, and repeat cautery was performed with successful closure of puncta. Conclusion: Symptoms and clinical signs of ATD in PCDE patients improve with punctal cautery.