Juan Murube, MD, PhD (Spain)

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Juan Murube, MD, PhD (Spain)

• THE TWO EASIEST SURGERIES TO TREAT
• DRY EYE
• 1. PUNCTUM PATCHING
• 2. CISTERNOPLASTY
• _____________________________

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WHY SPEAK ABOUT THE SURGICAL TREATMENT OF DRY EYE?

• DRY EYE IS THE MOST FREQUENT DISEASE IN
  OPHTHALMOLOGY.
• DRY EYE AND GLAUCOMA ARE AT PRESENT THE MOST
  FREQUENT CHRONIC MEDICAL TREATMENTS IN
  OPHTHALMOLOGY.
• ALL PEOPLE WILL SUFFER DRY EYE IF THEY LIVE LONG
  ENOUGH.
• AT PRESENT DRY EYE HAS NO CURE, AND TREATMENT
  IS ONLY PALLIATIVE
• IN THE NEAR FUTURE, SURGICAL TREATMENT OF DRY EYE
  WILL GREATLY INCREASE IN FREQUENCY.

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THE TRIPLE CLASSIFICATION OF DRY EYE

• I. ETIOPATHOGENIC II. HISTOGLANDULAR III.
  SEVERITY
• 1. Age-related A queo-deficient
  1. Mild.
• 2. Hormonal L ipo-deficient 2.
  Moderate
• 3. Pharmacologic M ucin-deficient
  3. Severe
• 4. Immunopathic E pitheliopathic
• 5. Hyponutritional N on ocular dryness
• 6. Dysgenetic
• 7. Adenitic
• 8. Traumatic
• 9. Neurodeprivative
• 10. Tantalic

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SURGICAL TREATMENT

• 1. SUPPLYING FLUID TO THE LACRIMAL POOL
• PAROTID DUCT TRANSPOSITION
• SALIVARY GLAND TRANSPLANTATION
• ABDOMINAL RESERVOIR
• 2. RETAINING FLUID IN THE LACRIMAL POOL
• PUNCTUM OCCLUSION
• CISTERNOPLASTY

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STENOs DUCT TRANSPOSITION, 1951
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TRANSPLANTATION OF MAJOR SALIVARY GLANDS
to the TEMPORAL FOSSA, 1986
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TRANSPLANTATION OF MINOR GLANDS (f.i.
labial) TO THE SURFOCULUS
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SUBCUTANEOUS ABDOMINAL RESERVOIRS
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SURGICAL TREATMENT

• 1. SUPPLYING FLUID TO THE SURFOCULAR POOL
• PAROTID DUCT TRANSPOSITION
• SALIVARY GLAND TRANSPLANTATATION
• ABDOMINAL RESERVOIR
• 2. RETAINING FLUID IN THE SURFOCULAR POOL
• PUNCTUM OCCLUSION
• CISTERNOPLASTY

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3 METHODS FOR THERMAL OCCLUSION1.
GALVANOCAUTEY2. DIATHERMY3. LASER
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PUNCTUM PLUGSiniciated by Freeman in 1975
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PUNCTUM OCCLUSION WITH SMART PLUGS
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PATCHING OF THE LACRIMAL PUNCTUM with autologous
conjunctiva
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PUNCTUM PATCHING with AUTOLOGOUS SKIN


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2, CISTERNOPLASTY

• -THE VOLUME OF A NORMAL LACRIMAL BASIN IS 7
  µl.
• A DROP OF ARTIFICIAL TEAR HAS 30 µl, AND
  OVERCHARGES THE LACRIMAL POOL.
• FIVE MINUTES AFTER INSTILLING THE DROP, THE
  LACRIMAL POOL RETURNS TO 7 µl.
• IT WAS MANDATORY TO LOOK FOR A SOLUTION TO THIS
  WASTE !

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CISTERNOPLASTY
A CISTERNOPLASTY QUADRUPLICATES THE CONTENT OF
THE LACRIMAL BASIN, AND THE TIME OF RETENTION
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THANKS FOR YOUR ATTENTION

• PUNCTUM PATCHING WITH
• 1. AUTOLOGOUS CONJUNCTIVA OR LID SKIN
• 2. AND CISTERNOPLASTY DO NOT CURE,
• BUT GREATLY IMPROVE THE LIFE OF PEOPLE
• DEFINED IN THE TRIPLE CLASSIFICATION OF DRY EYE
  AS HAVING MEDIUM AND SEVERE DRY EYE

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• GARRET

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ABDOMINAL RESERVOIR IS THE ONLY TECHNIQUE THAT
ALLOWS TO PERFORM A SUCCESSFUL KERATOPLASTY IN
TOTAL DRY EYES
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PUNTUM PLUGSiniciated by Freeman in 1975
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PUNCTUM PLUG
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CAUTERIZATION OF THE LACRIMAL CANALICULI

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TREATMENT OF DRY EYE

• 1. PSYCHOLOGIC
• 2. ENVIRONMENTAL
• 3. MEDICAL
• 4. SURGICAL

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PUNCTUM PATCHING with AUTOLOGOUS SKIN


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