3 Punctal occlusion is not appropriate for all patients who complain of dry eyes and burning. The diagnosis of dry eyes is not straightforward and is beyond the scope of this discussion. I am also unlikely to recommend the procedure for patients who have no corneal signs of dry eyes, such as superficial punctate keratitis. Many patients with very low Schirmer values have only minimal symptoms and do not need punctal occlusion. Contact lens wear can be associated with dry eyes in patients who are otherwise asymptomatic.
Dry eyes can be a symptom of tight lenses, and can be eliminated by refitting with looser lenses.
Many commonly used oral medications with antihistaminic or anticholinergic properties can also cause reversible ocular dryness. Punctal occlusion is not indicated when ocular dryness is a temporary condition. Blepharitis is a very common condition that causes symptoms similar to dry eyes and is frequently overlooked. Blepharitis and dry eyes frequently coexist and treatment of both is necessary. With blepharitis, ocular irritation is often present on awakening, whereas with dry eyes, symptoms usually worsen as the day goes on.