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TEAR RETENTION
While tear fluid supplements provide some relief from symptoms and are a convenient form of therapy,1 they may not be sufficient in severe cases of KCS. Patients who do not respond to topical medication require more aggressive therapy, and the most satisfactory regimen of therapy may best be achieved by the preservation of existing tears. This can be achieved through sealing the natural drainage channels that lead the tears to the nasal meatus. It has been suggested that 70 per cent of the pre-ocular tear volume drains via this route,2 the remainder being lost to evaporation and conjunctival absorption. Punctal occlusion evidently has the potential to conserve the volume of tears that normally drain through the lacrimal puncta, and the change may be observed as a physical increase in the height of the tear menisci.
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