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

So Min Ahn; Young Sub Eom; Jay Won Rhim; Su Yeon Kang; Hyo Myung Kim; Jong Suk Song

doi:10.3341/jkos.2016.57.2.195

Journal List > J Korean Ophthalmol Soc > v.57(2) > 1010486

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Ahn, Eom, Rhim, Kang, Kim, and Song: The Effects of Surgical Punctual Occlusion on Patients with Aqueous Deficient Dry Eye

Original Article

J Korean Ophthalmol Soc 2016;57(2):195-199.

Published online: 7 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.2.195

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

So Min Ahn, MD, Young Sub Eom, MD, Jay Won Rhim, MD, Su Yeon Kang, MD, Hyo Myung Kim, MD, PhD, Jong Suk Song, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Jong Suk Song, MD, PhD Department of Ophthalmology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul 08308, Korea Tel: 82-2-2626-3178, Fax: 82-2-857-8580 E-mail: crisim@korea.ac.kr

Received 27 March 2015 Revised 23 September 2015 Accepted 14 November 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: Corneal staining, Dry eye, Punctal occlusion, Sjögren syndrome

REFERENCES

1). Henrich CF, Ramulu PY, Akpek EK. Association of dry eye and inflammatory systemic diseases in a tertiary care–based sample. Cornea. 2014; 33:819–25.

2). Willis RM, Folberg R, Krachmer JH, Holland EJ. The treatment of aqueous-deficient dry eye with removable punctal plugs. A clinical and impression-cytologic study. Ophthalmology. 1987; 94:514–8.

3). Gilbard JP, Rossi SR, Azar DT, Heyda KG. Effect of punctal occlusion by Freeman silicone plug insertion on tear osmolarity in dry eye disorders. CLAO J. 1989; 15:216–8.

4). Balaram M, Schaumberg DA, Dana MR. Efficacy and tolerability outcomes after punctal occlusion with silicone plugs in dry eye syndrome. Am J Ophthalmol. 2001; 131:30–6.

5). Baxter SA, Laibson PR. Punctal plugs in the management of dry eyes. Ocul Surf. 2004; 2:255–65.

6). Bourkiza R, Lee V. A review of the complications of lacrimal occlusion with punctal and canalicular plugs. Orbit. 2012; 31:86–93.

7). Ohba E, Dogru M, Hosaka E, et al. Surgical punctal occlusion with a high heat-energy releasing cautery device for severe dry eye with recurrent punctal plug extrusion. Am J Ophthalmol. 2011; 151:483–7. e1.

8). Yang HY, Fujishima H, Toda I, et al. Lacrimal punctal occlusion for the treatment of superior limbic keratoconjunctivitis. Am J Ophthalmol. 1997; 124:80–7.

9). Law RW, Li RT, Lam DS, Lai JS. Efficacy of pressure topical anaesthesia in punctal occlusion by diathermy. Br J Ophthalmol. 2005; 89:1449–52.

10). Benson DR, Hemmady PB, Snyder RW. Efficacy of laser punctal occlusion. Ophthalmology. 1992; 99:618–21.

11). Liu D, Sadhan Y. Surgical punctal occlusion: a prospective study. Br J Ophthalmol. 2002; 86:1031–4.

12). Vrabec MP, Elsing SH, Aitken PA. A prospective, randomized comparison of thermal cautery and argon laser for permanent punctal occlusion. Am J Ophthalmol. 1993; 116:469–71.

13). Lemp MA. Report of the National Eye Institute/Industry workshop on Clinical Trials in Dry Eyes. CLAO J. 1995; 21:221–32.

14). Horwath-Winter J, Thaci A, Gruber A, Boldin I. Long-term retention rates and complications of silicone punctal plugs in dry eye. Am J Ophthalmol. 2007; 144:441–4.

15). Kim BM, Osmanovic SS, Edward DP. Pyogenic granulomas after silicone punctal plugs: a clinical and histopathologic study. Am J Ophthalmol. 2005; 139:678–84.

16). Kaido M, Goto E, Dogru M, Tsubota K. Punctal occlusion in the management of chronic Stevens-Johnson syndrome. Ophthalmology. 2004; 111:895–900.

17). Holzchuh R, Osaki TH, et al. Two-year outcome of partial lacrimal punctal occlusion in the management of dry eye related to Sjögren syndrome. Curr Eye Res. 2011; 36:507–12.

18). Lee JS, Choi W, Lee SS, Yoon KC. Prevalence and clinical aspects of Sjögren syndrome in dry eye patients. J Korean Ophthalmol Soc. 2012; 53:499–504.

19). Schiffman RM, Christianson MD, Jacobsen G, et al. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000; 118:615–21.

Figure 1.

Anterior segment photography of dry eye patient with rhematologic disease. (A) Pre-treatment (A-1: right/A-2: left). (B) After punctal plug insertion (B-1: right/B-2: left). (C) One month after surgical punctal occlusion (C-1: right/C-2: left).

Table 1.

Demographic and clinical data of subjects enrolled in this study

	Study group
No. of patients	8
Age (years)	53.4 ± 8.7
Gender (male/female)	1/7
OU/OD/OS	7/0/1
Secondary systemic disease (yes/no)	6/2
Sjogren's disease	4
Secondary Sjogren's disease	1
GVHD	1
Factor (positive/negative)
Ro	4/4
La	3/5
RF	3/5

Values are presented as mean ± SD unless otherwise indicated. OU = oculus unitas; OD = oculus dexter; OS = oculus sinister; GVHD = graft versus host disease; RF = rhematoid factor.

Table 2.

Comparison of pre and post-operative change

	Visual acuity (log MAR)	Symptom^*	Corneal staining^†	BUT (sec)
Pre	0.30 ± 0.37	3.67 ± 0.49	9.07 ± 3.01	1.47 ± 0.52
Post	0.14 ± 0.24	2.13 ± 1.06	4.67 ± 3.29	3.00 ± 1.69
p-value^‡	0.002	0.001	0.001	0.001

Values are presented as mean ± SD unless otherwise indicated.

log MAR = logarithm of the minimum angle of resolution; BUT = tear break-up time.

^* 0 no, 1 mild, 2 moderate, 3 moderate to severe, 4 severe; ^† National Eye Institute (NEI) score; ^‡ Wilcoxon signed rank test was used. p-value less than 0.05 was considered statistically significant.

Table 3.

The result of surgical punctal occlusion (last F/U)

	Total occlusion	Partial recanalization	Total recanalization
N	12	3	0
Percentage (%)	80.0	20.0	0

F/U = follow up.

Table 4.

Complications of punctal plug insertion

	Success	Plug loss	Granuloma	Ocular pain
N	2	10	1	2
Percentage (%)	13.3	66.7	6.7	13.3

TOOLS

Similar articles