Upper punctal occlusion versus lower punctal occlusion in dry eye

Area of Science:

• Ophthalmology
• Dry Eye Disease Research
• Tear Film Dynamics

Background:

• Dry eye disease (DED) affects millions globally, causing discomfort and visual impairment.
• Punctal occlusion is a common treatment to conserve the natural tear film.
• Comparing upper versus lower punctal occlusion effectiveness is crucial for optimizing DED management.

Purpose of the Study:

• To evaluate and compare the efficacy of upper punctal occlusion against lower punctal occlusion in patients with dry eye.
• To assess the impact of punctal occlusion on subjective symptoms and objective clinical signs of dry eye.

Main Methods:

• A comparative study involving 20 dry eye patients and 20 normal subjects.
• Collagen plugs were used for punctal occlusion: upper punctum in one eye, lower punctum in the contralateral eye.
• Real-time optical coherence tomography (OCT) was used to measure upper and lower tear menisci. Subjective symptom scores, corneal staining, Schirmer I test, and tear breakup time (TBUT) were also assessed.

Main Results:

• In dry eye patients, both upper and lower punctal occlusion improved symptoms, corneal staining, TBUT, and lower tear meniscus height (LTMH).
• No significant changes were observed in Schirmer test scores or upper tear meniscus height (UTMH) post-occlusion.
• There were no statistically significant differences in outcomes between upper and lower punctal occlusion in dry eye patients or in normal subjects.

Conclusions:

• Punctal occlusion with collagen plugs provides symptomatic relief and improves objective signs in dry eye patients.
• The effectiveness of upper and lower punctal occlusion is comparable for managing dry eye.
• Lower tear meniscus height (LTMH) serves as a reliable indicator for assessing the success of punctal occlusion therapy.