However, punctum and intracanalicular occlusion are only appropriate for certain patients with aqueous abnormalities, and it is important that a correct diagnosis is made to allow selection of suitable patients for the procedure.
In a retrospective examination of the effect of punctal occlusion on dry eye disorders using Freeman silicone plug insertion, a significant decrease in tear osmolarity was found together with a reduction in rose bengal staining in 75% of the eyes examined (Gilbard et al, 1989).
They suggest that occlusion of one punctum on one or both sides should be reserved for cases when insertion in the upper punctum is difficult.