In ophthalmology, thermal cautery often refers to using controlled heat to permanently close the tear drainage puncta in severe dry eye, or to shrink redundant tissue in some lid procedures. It creates a small burn that scars and seals the target area.
Punctal Cautery for Dry Eye
After local anaesthetic, a fine cautery probe is applied to the punctum and proximal canaliculus to intentionally scar them closed. This is considered when punctal plugs are insufficient or repeatedly fall out.
- Provides more durable occlusion than removable plugs
- Pain is usually mild, and healing occurs over days
- Can be reversed only with difficulty, so careful selection is essential
- Used mainly in severe aqueous‑deficient dry eye or ocular surface disease
Other Uses
Thermal cautery can also contour eyelid edges, treat small vascular lesions, or assist with haemostasis during surgery. Settings and application are tailored to minimise collateral damage.
- Post‑procedure care includes lubricants and sometimes topical antibiotics
- Over‑ or under‑occlusion can affect symptoms and may require adjustment
- Patients should be counselled about permanence before punctal cautery
- Regular monitoring of the ocular surface remains important after the procedure
