Punctal cautery is burning the tear duct opening so it scars closed. This procedure is typically performed in patients with severe dry eyes when punctal plugs aren’t working, most commonly because they keep falling out. Punctal cautery is performed in the office. A local anesthetic in injected into the area to be cauterized. Once it is numb, a small tip cautery is placed in the tear duct opening and it is burned closed. While it stays closed the majority of the time, it occasionally opens up, at which point it may need to be cauterized again.