Punctal plug

About: Punctal plug is a research topic. Over the lifetime, 278 publications have been published within this topic receiving 5445 citations. The topic is also known as: tear duct plug & lacrimal plug.

Dysfunctional tear syndrome: a Delphi approach to treatment recommendations.

Abstract: Purpose: To develop current treatment recommendations for dry eye disease from consensus of expert advice. Methods: Of 25 preselected international specialists on dry eye, 17 agreed to participate in a modified, 2-round Delphi panel approach. Based on available literature and standards of care, a survey was presented to each panelist. A two-thirds majority was used for consensus building from responses obtained. Treatment algorithms were created. Treatment recommendations for different types and severity levels of dry eye disease were the main outcome. Results: A new term for dry eye diseasewas proposed: dysfunctional tear syndrome (DTS). Treatment recommendations were based primarily on patient symptoms and signs. Available diagnostic tests were considered of secondary importance in guiding therapy. Development of algorithms was based on the presence or absence of lid margin disease and disturbances of tear distribution and clearance. Disease severity was considered the most important factor for treatment decision-making and was categorized into 4 levels. Severity was assessed on the basis of tear substitute requirements, symptoms of ocular discomfort, and visual disturbance. Clinical signs present in lids, tear film, conjunctiva, and cornea were also used for categorization of severity. Consensus was reached on treatment algorithms for DTS with and without concurrent lid disease. Conclusion: Panelist opinion relied on symptoms and signs (not tests) for selection of treatment strategies. Therapy is chosen to match disease severity and presence versus absence of lid margin disease or tear distribution and clearance disturbances.

Autologous serum eye drops for the treatment of severe dry eye in patients with chronic graft-versus-host disease

Abstract: We investigated the efficacy and safety of autologous serum eye drops for the treatment of severe dry eye after allogeneic haematopoietic stem cell transplantation (SCT). A total of 14 patients (four males and 10 females; median age, 31.0 years) with severe dry eye associated with chronic graft-versus-host disease (cGVHD) were enrolled in this study. All patients were refractory to treatment with conventional artificial tears. Autologous serum eye drops, a solution made of 20% autologous serum in sterile saline, were applied 10 times per eye per day. The patients were evaluated every 4 weeks according to visual acuity, corneal sensitivity, vital staining of the ocular surface, tear dynamics, and subjective assessments of symptoms (complaints scores). The median follow-up period was 19.4 months (range: 4-41 months). After 4 weeks of treatment, significant improvement was observed in both complaint scores (from 33.7+/-12.3 to 23.6+/-10.6 points; P<0.01) and fluorescein scores (from 5.8+/-2.0 to 2.4+/-0.9 points; P<0.005). Significant improvements were observed also in rose-bengal staining and tear break-up time. In seven of the 14 patients, the responses were maintained for 6-41 months (median:19.4+/-8.3 months), while six of the other seven patients required treatment with punctal plugs in addition to autologous serum eye drops. One of these other seven patients developed eczema around the eyelids, after which the treatment was discontinued. No serious adverse events were observed. We conclude that autologous serum eye drops are safe and effective for treating severe dry eye associated with cGVHD and that more efficient control of dry eye may be achieved by the combined use of autologous serum eye drops with punctal plugs.

Dry eye after refractive surgery.

Abstract: Photorefractive keratectomy and laser in situ keratomileusis can induce or exacerbate dry eye after surgery. This manifests as an increase in degree and frequency of symptoms, corneal findings, such as superficial punctate keratopathy, and abnormal results of dry eye tests, such as the Schirmer test and tear break-up time. The cause mainly involves decreased corneal sensation, resulting in decreased feedback to the lacrimal gland and reduced tear production. Other causes may include increased evaporation, inflammation, or toxicity of medications. Dry eye may result infrequently in impaired wound healing and decreased optical quality of the cornea, but it is transient, lasting from a few weeks up to 1 year. Patients should be warned about this distressing complication. During a period of dry eye, artificial tears and punctal plugs are helpful in preventing or alleviating patient discomfort.

Punctum plug and method for treating keratoconjunctivitis sicca (dry eye) and other ophthalmic aliments using same

Abstract: A plug of suitable dimension and material is removably inserted into the upper and/or lower punctal apertures of the eye to block the opening and the attendant canaliculus so as to thereby prevent the drainage of lacrimal fluid therethrough. The plug is comprised of tissue-tolerable, readily sterilizable material, such as polytetrafluorethylene (Teflon), or hydroxyethylmethacrylate (HEMA) hydrophilic polymer, methyl methacrylate, silicon, stainless steel or other inert metal material. The rod-like plug is formed with an oversized tip or barb portion that dilates and blockingly projects into the canaliculus, a smaller neck or waist portion upon which the punctum sphincter ring tightens, and a relatively larger, smooth head portion which rests upon the top of the punctal opening and prevents the plug from passing down into the canaliculus. In some embodiments the plug is impregnated with or otherwise acts as a carrier vehicle for an ophthalmic medication which is stored and delivered on a sustained release basis to the eye. A method for inserting the plug into the punctal opening is described, utilizing a dilator tool for enlarging the punctum and associated canaliculus and an inserter tool for facilitating the grasping, manipulation and insertion of the plug. The punctal plug has been found useful in treating keratoconjunctivitis sicca (dry eye) and is believed to be suitable for treating other ophthalmic ailments where retention of lacrimal fluid on the surface of the eye and in the lacrimal lake is desired or where sustained release of an ophthalmic medication to the eye by using the plug as a medication carrier is desired.