Effect of Punctal Occlusion in Dry-Eye Subjects
To determine the influence of punctal occlusion on tear film osmolarity and subject symptoms in subjects previously diagnosed with dry eye.
Twenty-eight subjects with previous diagnosis of dry eye and tear film hyperosmolarity (>308 mOsm/L) participated in this prospective multicenter study. All subjects were evaluated using tear film osmolarity, slit lamp examination of the cornea, eyelids and meibomian glands, tear film break up time (TBUT) and fluorescein staining of cornea and conjunctiva. Subjects also rated their frequency and severity of symptoms using the VAS questionnaire (0: none - 10: high). Study assessments were performed pre and 30 days post occlusion of the lower punctum in both eyes.
At baseline, mean tear film osmolarity at baseline visit was 339.82 ± 21.04 mOsm/L, TBUT was 4.02 ± 1.96 seconds, and subject reported symptom frequency and severity were 7.93 ± 2.11 and 6.79 ± 2.10. Following 4 weeks of punctal occlusion therapy, tear film osmolarity was the only sign to decrease significantly (-8.5 ± 16.42 mOsm/L, p < 0.01). The change in TBUT (0.57 ± 1.63 s), symptom frequency (-1.55 ± 2.46) and severity (-1.55 ± 2.11) was not clinically significant. Change in the categorical grade for staining will be discussed.
Punctal plug occlusion therapy decreases tear film osmolarity in dry eye subjects. Longitudinal studies are required to understand the long term changes in osmolarity versus subject symptoms.