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Effects of punctal occlusion on clinical signs, symptoms, and tear cytokines in patients with dry eye
Author(s) -
BEUERMAN R,
TONG LMG,
SIMONYI S,
HOLLANDER DA,
STERN ME
Publication year - 2014
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2014.4454.x
Subject(s) - medicine , ophthalmology , tears , irritation , staining , artificial tears , prospective cohort study , occlusion , surgery , pathology , immunology
Purpose To investigate changes in signs and symptoms, and tear cytokines following punctal plug occlusion. Methods In this prospective longitudinal study, parasol silicon plugs were inserted bilaterally in the lower punctum. Fluorescein corneal staining, tear film break up time (TBUT), Schirmer’s test, dry eye symptoms, tear cytokine levels, and safety were assessed in the more severe eye over 3 weeks. Results 23 females (mean age, 51.5 y) and 6 males (mean age, 44.7 y) with moderate dry eye were evaluated. Females had significantly worse global symptoms score (P=0.03) and TBUT (P=0.04) at baseline. At 3 weeks after occlusion, global irritability was significantly reduced (P<0.001). Fluorescein staining decreased in all (P<0.01) but the inferior zone; inferior staining was significantly reduced in patients with staining grade >1 at baseline (P<0.001). Patients with more severe dry eye had significantly greater improvements in TBUT (P=0.045) and Schirmer’s score (P=0.01). At baseline, there was no significant correlation between 16 key cytokines and either TBUT or global irritation symptoms; levels of several cytokines were higher in patients with low Schirmer’s scores (≤8 mm vs >8 mm), notably TNF‐α (P<0.001), IL‐2 (P<0.03) and MIP‐1α (P<0.002). After occlusion, no significant changes in raw tear cytokine levels were observed. Conclusion Punctal occlusion improved global irritation score and reduced fluorescein staining in all zones except inferior zone overall, but did not generally affect tear cytokine levels in dry eye patients.Commercial interest