To critically appraise the evidence on the efficacy and recanalization rates of permanent punctal occlusion via thermal or surgical means in managing dry eye disease (DED). In PubMed, Scopus, and Cochrane databases, two authors systematically reviewed the literature for prospective studies on punctal cautery or surgical occlusion (excluding punctal plugs) for DED. The studied outcomes were changes in tear volume, tear film stability, punctal recanalization rates, and patient symptomatology. Nine studies (all single-arm) had 150 subjects (96 females). Five studies were on thermal punctal cauterization, and four used surgical occlusion techniques. One hundred eighty puncta were operated for eyes not responding to maximal lubricants or recurrent plug extrusion. DED etiologies were Sjogren's syndrome (78), cicatricial ADDE (27), graft-versus-host disease (12), and non-SS DED (50). Follow-up ranged from 3 to 24 months. At the final follow-up, improvements in Schirmer I and TBUT were 2.5 mm and 0.8s with thermal and 2.1 mm and 0.6s with surgical methods, respectively (P = 0.17 for Schirmer, P = 0.18 for TBUT). Punctal recanalization rates varied between thermal (0–38.7 %) and surgical (5–9%) techniques (p = 0.22). Different cautery devices show different recanalization rates; disposable thermal cautery tips directly inserted into the punctum had lesser recanalization than radiofrequency monopolar cautery. Most patients reported subjective improvement following the procedure, but no quantification measure was given in the studies. None of the published studies had a comparison group for performing a meta-analysis. Based on non-comparative studies, thermal or surgical punctal occlusion improves tear volume in DED with similar recanalization rates; however, randomized controlled trials are needed to ascertain the real effects of punctal cautery on DED.

中文翻译：

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干眼病的泪点烧灼：系统评价


批判性地评价通过热或手术手段永久泪点闭塞治疗干眼病（DED）的功效和再通率的证据。在 PubMed、Scopus 和 Cochrane 数据库中，两位作者系统地回顾了针对 DED 的泪点烧灼或手术封堵（不包括泪点塞）前瞻性研究的文献。研究结果是泪液量、泪膜稳定性、泪点再通率和患者症状的变化。九项研究（均为单组）有 150 名受试者（96 名女性）。五项研究涉及热泪点烧灼，四项研究使用手术封堵技术。对一百八十个泪点进行了手术，这些眼睛对最大润滑剂或反复的塞子挤压没有反应。 DED 病因包括干燥综合征 (78)、瘢痕性 ADDE (27)、移植物抗宿主病 (12) 和非 SS DED (50)。随访时间为 3 至 24 个月。在最后一次随访中，热疗时 Schirmer I 和 TBUT 的改善分别为 2.5 毫米和 0.8 秒，手术方法分别改善 2.1 毫米和 0.6 秒（Schirmer 的 P = 0.17，TBUT 的 P = 0.18）。泪点再通率在热技术 (0–38.7%) 和手术技术 (5–9%) 之间存在差异 (p = 0.22)。不同的烧灼装置表现出不同的再通率；直接插入泪点的一次性热烧灼头比射频单极烧灼的再通程度要低。大多数患者报告手术后主观改善，但研究中没有给出量化指标。已发表的研究均未设置用于进行荟萃分析的对照组。 根据非比较研究，热泪点或手术泪点封堵可改善 DED 的泪液量，且再通率相似；然而，需要随机对照试验来确定泪点烧灼对 DED 的真正影响。