This is Richard Allen at the University of Iowa. This video demonstrates permanent punctal occlusion with a thermal cautery. The medial portion of the lower lid is anesthetized with placement of the anesthetic transconjunctivally. The patient had a previously placed punctal plug which is removed. The high temperature thermal cautery is then applied to the area of the punctum in order to induce scar. Some surgeons prefer placing the cautery within the punctum and canaliculus. I have not found that this is necessary. Antibiotic ointment can then be placed over the area.