1. Juan Murube, MD, PhD (Spain) THE TWO EASIEST SURGERIES TO TREAT DRY EYE: 1. PUNCTUM PATCHING 2. CISTERNOPLASTY _____________________________

2. 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.

3. THE TRIPLE CLASSIFICATION OF DRY EYE I. ETIOPATHOGENIC II. HISTOGLANDULARIII. 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

4. 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

5. STENO’s DUCT TRANSPOSITION, 1951

6. TRANSPLANTATION OF MAJOR SALIVARY GLANDS to the TEMPORAL FOSSA, 1986

7. TRANSPLANTATION OF MINOR GLANDS (f.i. labial) TO THE SURFOCULUS

8. SUBCUTANEOUS ABDOMINAL RESERVOIRS

10. 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

11. 3 METHODS FOR THERMAL OCCLUSION: 1. GALVANOCAUTEY 2. DIATHERMY 3. LASER

12. PUNCTUM PLUGS iniciated by Freeman in 1975

13. PUNCTUM OCCLUSION WITH SMART PLUGS

14. PATCHING OF THE LACRIMAL PUNCTUM with autologous conjunctiva

17. PUNCTUM PATCHING with AUTOLOGOUS SKIN

20. 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 !

21. CISTERNOPLASTY A CISTERNOPLASTY QUADRUPLICATES THE CONTENT OF THE LACRIMAL BASIN, AND THE TIME OF RETENTION

22. 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

23. GARRET

29. ABDOMINAL RESERVOIR IS THE ONLY TECHNIQUE THAT ALLOWS TO PERFORM A SUCCESSFUL KERATOPLASTY IN TOTAL DRY EYES

30. PUNTUM PLUGS iniciated by Freeman in 1975

31. PUNCTUM PLUG

32. CAUTERIZATION OF THE LACRIMAL CANALICULI

34. TREATMENT OF DRY EYE 1. PSYCHOLOGIC 2. ENVIRONMENTAL 3. MEDICAL 4. SURGICAL

35. PUNCTUM PATCHING with AUTOLOGOUS SKIN