Different minor surgical procedures may help in the treatment of DES.


Near the inner corner of each eyelid are small openings, called punctae, that are the beginning of the normal tear drainage system. A procedure known as punctal occlusion can help by decreasing the normal drainage of your tears off the eye and down the tear drainage system, into the back of your nose, and down your throat. This occlusion is usually a very simple office procedure and only takes a few minutes.


Different punctal plugs or lacrimal canalicular plugs can be placed at or just inside these openings to block the normal drainage of tears down the tear drainage system. Just like a stopper that you put in the drain of a sink to keep the water from flowing down the drain, these plugs keep the tears that you have from flowing down the tear drainage system. Therefore, your eyes stay more moist and comfortable, even if you have fewer tears. These plugs can usually be removed very easily, if necessary.


Sometimes, in severe cases of DES, these openings are permanently closed, usually by cautery (burning) or laser. This accomplishes the same thing as the plugs, but it is very difficult, if not impossible, to reverse.


Lateral tarsorrhaphy is a procedure during which the lateral (outside) one-third of your eyelids are sewn together to decrease the ability of your eye to open widely and to help your eye close more easily.


If stroke or nerve damage keeps your eyelids from closing properly, a small gold weight may be implanted into your upper eyelid to help it close.