The Effects of Surgical Punctual Occlusion on Patients with Aqueous Deficient Dry Eye

PURPOSE: To analyze the improvement of symptoms and signs of dry eye after surgical punctual occlusion and to evaluate the effects of secondary systemic disease in dry eye patients. METHODS: From March 2011 to July 2014, 15 eyes of 8 dry eye patients with a history of punctal plug insertion underwent surgical punctal occlusion. Schirmer test was measured based on mean 2.9 mm. The patients consisted of 4 dry eye patients with Sjogren's disease, 1 with rheumatoid arthritis, 1 with graft-versus-host disease (GVHD), and 2 with no secondary systemic disease. Preoperative and postoperative ophthalmic examinations of log MAR visual acuity, subjective symptoms, corneal staining (National Eye Institute [NEI] score), and tear break-up time (BUT) were performed and the effects of secondary systemic disease in dry eye patients were evaluated. The results of surgical punctual occlusion were analyzed. RESULTS: All patients showed a statistically significant improvement of log MAR visual acuity, subjective symptoms, corneal staining (NEI score), and tear BUT. The patients with rheumatoid-related diseases showed improved symptoms after surgery, but the patient with GVHD showed no significant improvement after surgery. Among the study patients, 80.0% showed completely closed punctum and 20.0% showed partial recanalization. CONCLUSIONS: Surgical punctal occlusion is an effective alternative in patients with severe aqueous deficient dry eye who show recurrent punctal plug loss or complications associated with punctal plugs.

Management of punctal occlusion post - viral conjunctivitis / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM: To evaluate the effect of different methods in managing punctual and canalicular stenosis as a complication of viral conjunctivitis. ?METHODS: A retrospective cohort study, including 35 cases of punctal stenosis post-viral conjunctivitis. Cases were diagnosed clinically and treated after 4wk of complete remission from epidemic keratoconjunctivitis. Patients were treated with mechanical dilatation, insertion of perforated silicon punctual plugs or the use of Mini-Monoka stent. ?RESULTS: Six out of 35 ( 17. 14%) had a satisfactory outcome by punctal dilatation alone. Punctal dilatation with insertion of perforated punctal plugs was done in 20 cases ( 57. 14%). Nine cases ( 25. 71%) had punctal dilatation with Mini - Monoka tube insertion. Disease severity and the use of Mini-Monoka silicon tube did not correlate with bilateral eye involvement or involvement of both upper and lower punctum. ?CONCLUSlON: Management of punctal occlusion post viral conjunctivitis may be treated easily using perforated punctal plugs. Silicon intubation with Mini-Monoka might be needed to manage resistant cases.

The Relationship between the Dacryoscintigraphy and the Satisfaction with Punctal Occlusion in Patients with Dry Eye Syndrome

PURPOSE: The purpose of this study was to assess the relationship between the result of dacryoscintigraphy and the effect of punctal occlusion in dry eye syndrome. METHODS: Dacryoscintigraphy was performed in 86 eyes with dry eye syndrome and collagen plugs were inserted into low punctum. We evaluated the relationship between the results of dacryoscintigraphy and the effect of punctal occlusion with collagen plugs. RESULTS: In 36 eyes, tear transit time was normal in dacryoscintigraphy (Group I). In 28 eyes, tear transit time was more than 20 minutes (Group II). In 18 eyes, no tear transit was seen during 60 minutes and after dripping of normal saline, tear transit was seen (Group III). In 4 eyes, there was no tear transit after dripping of normal saline (Group IV). Symptom reduction after punctal occlusion with collagen plugs was observed in 34 eyes (94%) of Group I and 22 eyes (79%) of Group II . There was no significant differences between the two groups. In Group III, symptom reduction was observed in 4 eyes (22%) and it showed significant differences between the other groups. CONCLUSIONS: According to this results, punctal occlusion in dry eye syndrome was not effective in patients who showed tear transit after 60 minutes.

The Changes of Tear Osmolarity and Protein After Silicone Punctal Plug Insertion In Dry Eye

PURPOSE: To evaluate the changes of tear osmolarity and protein after silicone punctal plug insertion in dry eye. METHODS: We collected tear from 21 dry eyes (11 males and 10 females) with porous polyester rod(Transorb(R)) before silicone punctal occlusion and 2 weeks after the procedure. Tear osmolarity was measured by Fiske 2400 Osmometer(R). Total tear protein concentration was analyzed by Bradford's assay. The concentration of human serum albumin (HSA), lactoferrin, lysozyme were measured by Bio-Rad Gel Doc 2000(R). RESULTS: The tear osmolarity was changed from 364.48+/41.39 mOsm/L to 327.48+/-27.24 mOsm/L after the punctal occlusion (P<0.05). There were no changes of total protein concentration, Human serum albumin, lactoferrin, but lysozyme was increased statistically significantly (P<0.05). CONCLUSION: Silicone punctal occulusion decreases tear osmolarity in dry eye. This decrease is associated with a decrease in ocular surface disease due to high tear osmolarity. Only lysozyme except HSA and lactoferrin was increased significantly. Silicone punctal plug is an effective procedure for dry eye patients, but further investigation of the effects on tear proteins is needed.

Clinical Effects of Punctal Occlusion Using Chromic Catgut

The treatment of dry eye patients is based on the management of the main causes of the disease. When the process of disease continues regardless of various conventional treatments, punctal occlusion can be employed. We used collagen implant. 1-0 and 2-0 chromic catgut in 33 eyes of dry eye patients to evalute the efficacy of punctal occlusion using chromic catgut. Symptoms(grade 0 to 3) were improved from the first week and persistently decreased in symptom grade during four weeks' follow-up period. The superficial corneal punctate erosion(grade 0 to 3) was improved after 2 weeks of the procedure in the whole 33 eyes(p<0.05). There was no superiority between collagen implant and chromic catgut. There was no improvement by score of the Schirmer test and the BUT in each group(p<0.05). We concluded that chromic catgut was easily applicable, very effective, inexpensive and showed less complication compared with collagen implant. We suggested that it could be used more widely in punctal occlusion in dry eye patients.