A Preliminary Comparison of Superior and Inferior Silicone Punctal Occlusion in Hydrogen Contact Lens Wearers with Dry Eye Signs and Symptoms by H.Jeffries Ward, O.D.

Title

A Preliminary Comparison of Superior and Inferior Silicone Punctal Occlusion in Hydrogel Contact Lens Wearers with Dry Eye Signs and Symptoms

Author

H. Jeffries Ward, O.D.

Purpose

To investigate and compare the effects of superior and inferior silicone punctal occlusion in hydrogel contact lens wearers with dry eye signs and symptoms.

Methods

An 8-week, prospective, placebo-controlled study design was followed. A total of 10 subjects, 8 females and 2 males, were recruited based on specific signs and symptoms of dry eye with hydrogel contact lens wear. Tear film break-up time (TBUT), tear-production, fluorescein and lissamine-green staining were monitored throughout the study, as were the symptoms of dryness, lens awareness, and blur. After baseline levels of these signs and symptoms were established, one previously randomized eye was chosen as the treatment eye, with the other eye serving as a control. Superior and inferior silicone punctal occlusion were performed separately in the treatment eye, with a washout period being used between treatment methods.

Results

Both superior and inferior silicone punctal occlusion were shown to significantly diminish the symptoms of dryness, lens awareness, and blur. When compared directly, however, neither treatment method was found to be statistically more effective in reducing these symptoms. TBUT, tear production, fluorescein bulbar staining, and lissamine green corneal staining were shown to be unaffected by either method. While inferior occlusion was shown to have no effect on fluorescein corneal and lissamine green bulbar staining, some (but not all) analyses showed that superior occlusion approached a statistically significant effect.

Conclusion

Superior and inferior silicone punctal occlusion appear to be equivalent methods in the treatment of hydrogel contact lens wearers with dry eye signs and symptoms. If similar larger scale studies go on to substantiate the findings of this preliminary study, then the decision as to whether or not to occlude superior or inferior puncta should be based on a careful evaluation of eyelid anatomy. In other words, clinicians should occlude those puncta least likely to abrade a patient's conjunctiva or cornea.