Punctal and intracanalicular occlusion—a guide for the practitioner

Abstract

For example, a common cause of tear lipid deficiency is meibomian gland dysfunction secondary to staphylococcal blepharitis. The bacteria produce enzymes which break down the lipid surface of the tears. When examined with the slit lamp biomicroscope there may a fast tear break up time together with superficial punctate epithelial staining inferiorly particularly in the 4 and 8 o'clock positions as well as corneal infiltrates. The use of plugs in such a case would be inappropriate and contraindicated because a possible contributory cause of the dry eye is a bacterial infection which requires treatment. On the other hand, for example, in keratoconjunctivitis sicca associated with Sjogren's syndrome (dry eye, dry mouth and arthritis) there may be a band of corneal and conjunctival staining with rose Bengal and fluorescein in the absence of lid margin disease.