Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery
CPT4 code
Name of the Procedure:
Closure of the lacrimal punctum by thermocauterization, ligation, or laser surgery
Summary
This procedure involves closing the lacrimal punctum (the small openings in the eyelids through which tears drain) to treat excessive tearing. It can be done using methods such as thermocauterization (heat), ligation (tying off), or laser surgery.
Purpose
The procedure is designed to treat excessive tearing (epiphora) caused by an overactive tear system or blockages further down the tear drainage system. The goal is to prevent tears from draining too quickly, thereby reducing tearing and improving comfort and vision.
Indications
- Chronic epiphora (excessive tearing)
- Inadequate tear film due to rapid tear drainage
- Symptoms unresponsive to other treatments
- Dry eye syndrome where tear retention is necessary
Preparation
- Patients may need to stop using certain medications such as blood thinners.
- Pre-procedure eye exam and assessment of tear drainage system.
- Fasting is generally not required.
Procedure Description
- The eye area is cleaned and local anesthesia is administered.
- Depending on the method chosen (thermocauterization, ligation, or laser surgery):
- Thermocauterization: A heated instrument is used to close the punctum by causing tissue coagulation.
- Ligation: The punctum is tied off with a small suture to prevent tears from draining.
- Laser Surgery: A laser beam is used to seal the punctum.
- The procedure is typically quick with minimal discomfort.
Duration
The procedure usually takes about 10-20 minutes.
Setting
This procedure is typically performed in an outpatient clinic or surgical center.
Personnel
- Ophthalmologist or an eye surgeon
- Nursing staff for assistance and patient care
Risks and Complications
- Infection
- Inflammation or irritation of the eye
- Overcorrection leading to insufficient tear drainage
- Scarring at the punctum site
- Rarely, vision problems or prolonged discomfort
Benefits
- Reduction or elimination of excessive tearing.
- Improved comfort and visual clarity.
- The effects are usually noticeable soon after the procedure.
Recovery
- Post-procedure care includes using prescribed eye drops to prevent infection and reduce inflammation.
- Avoid rubbing eyes and follow up as scheduled.
- Recovery time is generally short; patients can resume normal activities within a day or two but should avoid strenuous activities for a week.
Alternatives
- Punctal plugs (temporary or permanent) to block tear drainage.
- Medications to adjust tear film composition.
- Surgical procedures to address underlying causes of excessive tearing.
- Each alternative has its own pros and cons, often depending on the underlying condition and patient preference.
Patient Experience
Most patients experience a quick and relatively painless procedure due to local anesthesia. Post-procedure, there may be mild discomfort or a sensation of dryness. Any discomfort is typically managed with over-the-counter pain relief and prescribed eye drops. Overall, the procedure improves the quality of life by addressing the underlying issue of excessive tearing.