To analyze the improvement of symptoms and signs of dry eye after surgical punctual occlusion and to evaluate the effects of secondary systemic disease in dry eye patients.

From March 2011 to July 2014, 15 eyes of 8 dry eye patients with a history of punctal plug insertion underwent surgical punctal occlusion. Schirmer test was measured based on mean 2.9 mm. The patients consisted of 4 dry eye patients with Sjogren's disease, 1 with rheumatoid arthritis, 1 with graft-versus-host disease (GVHD), and 2 with no secondary systemic disease. Preoperative and postoperative ophthalmic examinations of log MAR visual acuity, subjective symptoms, corneal staining (National Eye Institute [NEI] score), and tear break-up time (BUT) were performed and the effects of secondary systemic disease in dry eye patients were evaluated. The results of surgical punctual occlusion were analyzed.

All patients showed a statistically significant improvement of log MAR visual acuity, subjective symptoms, corneal staining (NEI score), and tear BUT. The patients with rheumatoid-related diseases showed improved symptoms after surgery, but the patient with GVHD showed no significant improvement after surgery. Among the study patients, 80.0% showed completely closed punctum and 20.0% showed partial recanalization.

Surgical punctal occlusion is an effective alternative in patients with severe aqueous deficient dry eye who show recurrent punctal plug loss or complications associated with punctal plugs.