Punctoplasty: Post Operative Care

 

After Your Punctoplasty: What to Expect & How to Care for Your Eye

By Sandra Lora Cremers, MD, FACS  |  Visionary Eye Doctors, Rockville, MD

You just had a punctoplasty — a minor surgical procedure to open or enlarge the tiny drain (called the punctum) on the edge of your eyelid that allows tears to flow properly into your tear drainage system. This procedure is commonly performed to relieve tearing, improve dry eye, or treat a blocked punctum. Most patients do very well and recover quickly. The instructions below will help you heal smoothly and get the best results.

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💊 Medications

Antibiotic + Steroid Eye Drop (NPD Drop)

Your doctor has prescribed a neomycin-polymyxin B-dexamethasone (NPD) combination eye drop — a single drop that contains both an antibiotic and a mild steroid to prevent infection and reduce inflammation at the surgical site.

• Dose: 1 drop in the operated eye
• Frequency: 3 times per day (morning, midday, and evening)
• Duration: 3 days

⚠️ If you have a known allergy to neomycin or any component, notify our office immediately so we can substitute an appropriate alternative.

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🧊 Cold Compresses — First 48 Hours

Immediately after surgery and for the first 48 hours, use cold compresses to minimize swelling, bruising, and discomfort.

• Use a clean cloth or gauze pad dampened with cold water, or a gel ice pack wrapped in a thin cloth.
• Apply gently to the closed eyelid — do not press directly on the eye.
• Apply for 10–15 minutes at a time, 3–4 times per day (or as often as needed for comfort).
• Never apply ice directly to skin.

♨️ Warm Compresses — After 48 Hours

Starting Day 3 (approximately 48 hours after surgery), transition to warm compresses to promote healing, reduce crusting, and help keep the newly opened punctum clear.

• Use a clean washcloth soaked in comfortably warm water (not hot).
• A pre-made warm compress mask (e.g., Bruder mask) is also excellent — microwave per package instructions.
• Apply to the closed eyelid for 5–10 minutes, 2–4 times per day.
• Continue warm compresses for at least 1–2 weeks after surgery to support healing and drainage.
• After each warm compress session, gently clean the lid margin with a lid wipe or diluted baby shampoo as directed.

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🔍 What to Expect After Surgery

Some mild swelling, redness, and tearing in the first day or two is completely normal. You may notice:

• A small amount of crusting or discharge at the inner corner of the eye — gently clean with a damp cotton pad.
• Mild discomfort or a "foreign body" sensation at the eyelid margin.
• Slight increase in tearing initially, which typically resolves as the punctum heals and drainage improves.
• A tiny scab or crusting at the punctal opening — this is normal and should not be picked or rubbed.

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✅ Do's & ❌ Don'ts

✅ Please DO	❌ Please AVOID
Use your NPD drops as prescribed	Rubbing or touching the operated eye
Apply cold compresses for first 48 hours	Swimming or submerging face in water for 2 weeks
Transition to warm compresses after 48 hours	Wearing eye makeup for at least 1 week
Keep the area clean and dry	Using contact lenses until cleared by your doctor
Attend all follow-up appointments	Strenuous exercise or heavy lifting for 48–72 hours

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🚨 Call Us Immediately If You Experience:

• Increasing pain, redness, or swelling after the first 48 hours
• Yellow or green discharge from the eye
• Fever over 101°F
• Sudden decrease in vision
• Any concern that doesn't feel right to you — we are always here to help

📞 Visionary Eye Doctors: (301) 340-0001  |  After hours, follow the recorded instructions for urgent calls.

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📅 Your Follow-Up

Your post-operative visit is typically scheduled 1–2 weeks after your procedure. At this visit, Dr. Cremers will examine the healing of your punctum, ensure it remains open, and discuss whether any additional treatment or dilation is needed. Please keep this appointment even if you feel completely fine.

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This information is intended as general postoperative guidance. Always follow the specific instructions provided to you by Dr. Cremers or her clinical team, as your individual care plan may differ. This content is for educational purposes and does not constitute medical advice for those outside our practice.

Sandra Lora Cremers, MD, FACS
Visionary Eye Doctors | Rockville, MD
Affiliated with Johns Hopkins Medicine at Suburban Hospital
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