Dry eye is a condition in which a person’s tears do not keep the eyes properly lubricated. It may be due to insufficient tear production or the increased evaporation of tears.

Dry eye is a common condition that is often temporary but may be long lasting for some people. Chronic dry eye often results from changes in hormone levels or underlying autoimmune or inflammatory conditions.

In most cases, people can manage chronic dry eye with over-the-counter or prescription eye drops and lifestyle adjustments. However, chronic dry eye can sometimes be difficult to treat. In these cases, surgical procedures may be the best way to help improve the symptoms.

Read on to learn more about the surgical treatment options for chronic dry eye.

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The specific purpose of surgery for chronic dry eye depends on the type of procedure. The possible goals include:

  • adding tears
  • conserving tears
  • increasing tear production
  • treating the underlying cause of inflammation

If chronic dry eye persists despite a person using the standard treatment options, an eye doctor, or ophthalmologist, may recommend one of several types of surgical procedures to help reduce the symptoms of dry eye and improve eye health.

Each type of surgery has different procedural methods, leading to different benefits and risks.

Punctal plugs

One of the most common surgical procedures to treat chronic dry eye is the insertion of punctal plugs, also known as tear duct plugs.

The puncta are the small openings in the corner of the eye that allow the drainage of tears. This procedure involves the insertion of small plugs into the puncta of the upper or lower eyelid, or both, to stop fluid from draining from the eye.

The lack of drainage keeps the surface of the eye moist, which can help relieve itching, burning, and redness.

During the procedure, the doctor may sometimes use anesthesia to numb the tear ducts. The insertion of punctal plugs is generally painless, but a person might feel some pressure during the procedure. There is no recovery period, and many people can resume their regular activities immediately.

There are two types of punctal plugs: temporary or dissolving plugs and semi-permanent plugs. The latter are suitable to use for months to years, but an ophthalmologist can remove them if necessary.

The most common side effect of punctal plugs is an itchy or irritating feeling in the corner of the eye after insertion, which may go away on its own. Some people may find that their eyes are too watery afterward.

Intense pulsed light therapy

Intense pulsed light therapy, or IPL therapy, is a noninvasive surgical procedure that uses infrared light to break down small blood vessels in the oil glands of the eye. The dysfunction of these glands, known as meibomian glands, is a common cause of dry eye.

In healthy eyes, the meibomian gland produces oils that help protect the surface of the eye. In people with meibomian gland dysfunction, abnormal oil production leaves the eye vulnerable to irritation, inflammation, and infection.

During IPL therapy, a doctor uses a handheld device to apply infrared light directly to the eyelids. The treatment takes approximately 10 minutes, and a person can receive it up to four times a year.

In a 2015 study involving 78 people with severe dry eye, 93% reported treatment satisfaction with regard to their dry eye symptoms after seven treatment visits and an average of four maintenance visits.

Although the effects of IPL therapy are unlikely to be permanent, people can expect long-term benefits lasting up to 9 months.

Side effects of IPL therapy are relatively uncommon, but they may include discoloration, swelling, blistering, and conjunctival cysts. Experts generally do not recommend IPL therapy for people with dark skin.

Thermal cautery

In some cases, punctal plugs can fall out on their own if the insertion is incorrect or there have been multiple repeats of the procedure. In such cases, doctors may recommend surgically closing the puncta using heat, which is known as thermal cauterization.

This procedure permanently closes the tear ducts in both eyes to prevent the draining of tears, which keeps moisture on the surface of the eye.

In a 2021 study involving 80 people with various eye conditions, including chronic dry eye, 54% had an improvement in their symptoms after thermal cautery. Between the start of the study and a 12-month follow-up, the number of participants with severe dry eye reduced from 21% to 6%.

This procedure takes place in an ophthalmology office and requires local anesthesia. Side effects are uncommon but may include excessive tearing.

Laser surgery

Laser in situ keratomileusis surgery, which people commonly call LASIK surgery, can often cause temporary dry eye during recovery.

However, research suggests that up to 65% of people with pre-existing dry eye symptoms experience complete resolution of their symptoms by 3 months after the surgery.

To protect against dry eye in the early postsurgery stages, an ophthalmologist may prophylactically prescribe eye drops or punctal plugs to prevent issues from arising.

Minor salivary gland transplant

In some cases, such as in individuals with underlying health conditions, severe chronic dry eye is untreatable with minimally invasive procedures and may eventually lead to blindness. One possible solution in these cases is a surgical procedure known as minor salivary gland transplant (MSGT).

An MSGT involves the transplantation of minor salivary glands from the mouth to the eyelid to provide lubrication to the surface of the eye. Small studies involving people with Stevens-Johnson syndrome or mucous membrane pemphigoid have shown that MSGT can help improve symptoms of dry eye.

Amniotic membrane

The amniotic membrane (AM) is a layer of tissue that it is possible to obtain from the placenta during elective cesarean section procedures. The AM contains a variety of fibers, growth factors, and cells that possess anti-inflammatory and anti-scarring properties.

Research suggests that the application of AM to the eye is a safe and effective solution for managing a variety of ocular conditions, including chronic dry eye.

There are two types of AM:

  • Cryopreserved AM: This type is frozen prior to use. It attaches to a polycarbonate ring or elastic band, and doctors apply it directly to the eye like a contact lens.
  • Dehydrated AM: Low temperature heat preserves this type of AM to protect the cellular components. Doctors apply it directly to the surface of the eye, using an overlying bandage contact lens to hold it in place.

Before use, the AM undergoes screening for transmissible diseases and treatment with broad-spectrum antibiotics to prevent infection.

Traditionally, the application of AM occurs in an operating room, but in-office application is becoming more common. The AM dissolves on its own, but removal of the polycarbonate ring or elastic band may be necessary with cryopreserved AM.

Although eye drops and lifestyle adjustments can help many people manage dry eye, others may experience ongoing, persistent symptoms. For people who find standard treatment options ineffective in relieving chronic dry eye, a variety of surgical options is available.

If a person’s dry eye symptoms do not improve with treatment, an ophthalmologist can help them determine whether a surgical solution is right for them. Most surgeries for chronic dry eye are minimally invasive, have few side effects, and require minimal recovery time.