Tuesday, July 10, 2012

Abstract: Punctal occlusion, tear meniscus & the contact lens wearer

I am not fond of this kind of study... Well of course plugs are going to make a contact lens wearer more comfortable. But do we really want to perpetuate contact lens use in people who are dry eye enough to need plugs?

To investigate by ultrahigh resolution optical coherence tomography the effect of punctal occlusion on tear menisci in symptomatic and asymptomatic contact lens wearers.
Symptomatic subjects with self-reported dry eyes (n = 20) and asymptomatic subjects (n = 20) were recruited. For each subject, 1 eye was randomly chosen for both upper and lower punctal occlusion with collagen plugs. Ultrahigh resolution optical coherence tomography imaged both upper and lower tear menisci before punctal occlusion, and 1, 4, 7, and 10 days afterward. Comfort scoring, noninvasive tear break-up time, tear break-up time, and Schirmer test with anesthesia were also performed.
Tear meniscus variables in the symptomatic group were lower than those in the asymptomatic group (P < 0.05) at all time points except for day 4. In the symptomatic group, the tear menisci were increased up to day 4 after punctal occlusion (P < 0.05). The increase was present only on day 1 in the asymptomatic group. Improvement of comfort scores and noninvasive tear break-up time occurred in both groups after occlusion (P < 0.05). The comfort scores were linearly correlated with the tear volumes after punctal occlusion, with higher correlation coefficients in the symptomatic group.
Punctal occlusion transiently increased tear menisci in symptomatic and asymptomatic lens wearers, with a longer duration in the symptomatic group. For both symptomatic and asymptomatic lens wearers, the increased meniscus volume was associated with improved ocular comfort.

Cornea. 2012 Jun 8. [Epub ahead of print]
Li M, Wang J, Shen M, Cui L, Tao A, Chen Z, Ge L, Lu F.
*School of Ophthalmology and Optometry †Department of Ophthalmology, Eye Hospital, Wenzhou Medical College, Wenzhou, Zhejiang, China ‡Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL.


Crystal said...

Yes, I agree. My corneal specialist told me for years to abandon all hope of ever (comfortably/safely) wearing contact lenses again. Even after I had punctal cautery and had great sign/symptom improvement, he STILL told me it's not a good idea [for dry eye patients] to wear lenses.

Rebecca said...

Crystal, I really respect doctors who are willing to take that position! Especially since the fact is, some people are so determined to wear lenses that they will simply move on to another doctor.