Efficacy of Punctal Occlusion in Management of Dry Eyes after Laser In Situ Keratomileusis for Myopia

• Published in: Current eye research Vol. 39; no. 3; pp. 257 - 262
• Main Authors: Alfawaz, Abdullah M., Algehedan, Saeed, Jastaneiah, Sabah S., Al-Mansouri, Samir, Mousa, Ahmed, Al-Assiri, Abdullah
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare USA, Inc 01.03.2014; Taylor & Francis
• Subjects: Adult; Cornea - surgery; Dry Eye Syndromes - etiology; Dry Eye Syndromes - prevention & control; Dry Eye Syndromes - surgery; Dry eyes; Female; Follow-Up Studies; Humans; Keratomileusis, Laser In Situ - adverse effects; Lacrimal Apparatus - surgery; LASIK; Male; myopia; Myopia - surgery; Ophthalmic Solutions - administration & dosage; punctal occlusion; punctal plug; Silicones; Surgical Instruments; Tears; Treatment Outcome; Visual Acuity; Young Adult
• ISSN: 0271-3683; 1460-2202
• DOI: 10.3109/02713683.2013.841258

Abstract Purpose: To evaluate the effect of punctal plug use in preventing dry eye after laser in situ keratomileusis (LASIK). Materials and Methods: A randomized clinical trial at a tertiary eye care center, Riyadh, Saudi Arabia. Participants underwent LASIK for myopia in both eyes and a lower punctal occlusion in one eye only while the other eye served as control. Both eyes received the same postoperative medications except for lubricant duration (subject eye: four times per day for one week; control eye: four times per day for 6 months). Participants were evaluated at 1 week, 2, and 6 months after surgery for signs and symptoms of dry eye. The main outcome measures were visual acuity; ocular surface parameters; and Ocular Surface Disease Index questionnaire. Results: Seventy-eight eyes of 39 patients were included in this study. The Ocular Surface Disease Index scores of eyes with punctal plugs were better at all follow-up visits, and the differences between both eyes were statistically significant (1 week, p < 0.0001; 2 months, p < 0.0001; 6 months, p = 0.008). At the final follow-up visit, the percentage of normal eyes was higher in eyes with punctal plugs for all ocular surface parameters (Schirmer 1 test, 94.9%; tear breakup time, 77.8%; punctate epithelial keratitis score, 71.8%) compared to eyes without occlusion (Schirmer 1 test, 92.3%; tear breakup time, 58.3%; punctate epithelial keratitis score, 53.8%); however, such differences were not statistically significant. Conclusion: Punctal plug insertion after LASIK surgeries may minimize the need for frequent lubricant application and hence improve patient satisfaction.