After the procedure, contact lens patients almost invariably report that they can wear their lenses longer and more comfortably. I believe you shouldn't wait until your patient goes from moderate to severe dry-eye symptoms before you do the procedure. Nearly everyone with KCS may benefit from punctal occlusion. Younger patients who still have some tear production have a very good response to the procedure. The people you have to be cautious with, however, are those over the age of 55 who complain of tearing, and others over 55 with really severe ocular surface disease as demonstrated by the dye.
Punctal occlusion is safe for women who develop dry-eye symptoms while taking oral contraceptives.
The procedure is even safe for teen-agers with dry eyes. I have done it on patients as young as 12. Some patients, primarily the elderly with very dry eyes, see better after punctal occlusion, because the procedure will improve the tear film. Even patients with very dry eyes derive some benefit from punctal occlusion, because artificial tears will remain in their eyes longer after the procedure. Occasionally, a patient will complain of frequent tearing following punctal occlusion.