Elsevier

The Ocular Surface

Volume 14, Issue 2, April 2016, Pages 233-241
The Ocular Surface

Original Research
Effects of Punctal Occlusion on Clinical Signs and Symptoms and on Tear Cytokine Levels in Patients with Dry Eye

https://doi.org/10.1016/j.jtos.2015.12.004Get rights and content
Under a Creative Commons license
open access

Abstract

Purpose

To investigate changes in signs, symptoms, and tear cytokines following punctal plug occlusion in patients with dry eye.

Methods

A single-center study was conducted at Singapore Eye Research Institute. Nonabsorbable punctal plugs were inserted in the lower punctum of both eyes in patients with moderate dry eye. Over 3 weeks, in the more severe eye, dry eye symptoms, fluorescein corneal staining, Schirmer I (without topical anesthesia) test, tear film breakup time (TFBUT), and safety were assessed. Cytokine and matrix metalloproteinase-9 (MMP-9) levels in tear samples were measured.

Results

Twenty-nine patients (mean age 49.8 years) with moderate dry eye were evaluated. At baseline, mean (standard deviation) global symptoms score was 53.8 (26.5), Schirmer I test score was 5.1 (2.8) mm, and TFBUT was 2.2 (0.6) seconds. After 3 weeks, punctal occlusion significantly reduced global irritation symptoms score (P<.001) and decreased fluorescein staining in all zones (P<.01) except the inferior zone (P=.42). No significant association between levels of cytokines or MMP-9 and either TFBUT or global irritation symptoms were observed at baseline. Levels of several cytokines and MMP-9 were higher in patients with Schirmer I test scores ≤8 mm at baseline. After 3 weeks of punctal occlusion, no significant changes in overall cytokine or MMP-9 levels were observed.

Conclusions

Punctal plug occlusion provided symptomatic relief and reduced fluorescein staining in all except the inferior zone. However, insertion of punctal plugs had minimal effect on tear cytokines and MMP-9 levels, suggesting a need for earlier treatment with anti-inflammatory agents for management of dry eye disease.

Key Words

cytokine
dry eye
matrix metalloproteinase
punctal plug
tear

Cited by (0)

This study was sponsored by Allergan plc, Dublin, Ireland. Writing and editorial assistance was provided to the authors by Kakuri Omari, PhD, of Evidence Scientific Solutions, Philadelphia, PA, USA, and funded by Allergan plc. All authors met the ICMJE authorship criteria. Neither honoraria nor payments were made for authorship.

Disclosures: L. Tong has nothing to disclose; R. Beuerman has served as a consultant to Allergan plc, AB SCIEX, and Santen and holds patents in the field of research; S. Simonyi and D.A. Hollander are employees of Allergan plc; M.E. Stern was an employee of Allergan plc at the time the study was conducted.

Single-copy reprint requests to Louis Tong, MBBS, FRCS, DM, PhD (address below).