Management of corneal perforations in dry eye disease: Preferred practice pattern guidelines

Corneal perforations in eyes with dry eye disease (DED) are difficult to manage due to the interplay of several factors such as the unstable tear film, surface inflammation, and the underlying systemic disease affecting the wound healing process, and the eventual outcome. A careful preoperative examination is required to identify the underlying pathology, and status of ocular surface and adnexa, rule out microbial keratitis, and order appropriate systemic workup in addition to assessing the perforation itself. Several surgical options are available, which include tissue adhesives, multilayered amniotic membrane grafting (AMT), tenon patch graft (TPG), corneal patch graft (CPG), and penetrating keratoplasty (PK). The choice of procedure depends upon the size, location, and configuration of the perforation. In eyes with smaller perforations, tissue adhesives are effective treatment modalities, whereas AMT, TPG, and CPG are viable options in moderate-sized perforations. AMT and TPG are also preferable in cases where the placement of a bandage contact lens may be a challenge. Large perforations require a PK, with additional procedures such as tarsorrhaphy to protect the eyes from the associated epithelial healing issues. Conjunctival flaps are considered in eyes with poor visual potential. The management of the acute condition is carried out in conjunction with measures to improve the tear volume bearing in mind the chances of delayed epithelialization and re-perforation in these cases. Administration of topical and systemic immunosuppression, when indicated, helps improve the outcome. This review aims to facilitate clinicians in instituting a synchronized multifaceted therapy for the successful management of corneal perforations in the setting of DED.

Preliminary clinical observation of Smart Plug canalicular plug for the treatment of aqueous-deficient dry eye / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To discuss the effect of Smart Plug canalicular plug on aqueous-deficient dryeye. METHODS:Forty-eight cases of aqueous-deficient dry eye patients in our hospital from May 2012 to April 2013 were selected for the study. After treated by Smart Plug canalicular plug, postoperative clinical efficacy, foundation Schirmer I test ( SIt) , tear film break-up time ( BUT ) , corneal fluorescein staining ( FL ) changes were observed. RESULTS: Forty-eight patients were cured, 31 cases were markedly effective(65%), effective 14 cases (29%), invalid in 3 cases (6%), the total effective rate was 94%. Before treatment, SⅠt, BUT, and FL was ( 3. 49±1. 24 ) mm/5min, ( 3. 15±1. 07 ) s, and ( 2. 52±0. 11 ) points, respectively. After treatment, SIt, BUT, FL were significantly improved compared with before treatment, the difference was statistically significant (PCONCLUSION: Smart Plug canalicular plug is an effective treatment for aqueous-deficient dry eye, can effectively relieve symptoms, worthy of promotion.