September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Effect of punctal occlusion on blinks in eyes with severe aqueous tear deficient dry eye
Author Affiliations & Notes
  • Hiroaki Kato
    Department of Ophthalmology, Kyoto Prefectural Univ of Medcine, Kyoto City Kamigyoku, Kyoto, Japan
  • Norihiko Yokoi
    Department of Ophthalmology, Kyoto Prefectural Univ of Medcine, Kyoto City Kamigyoku, Kyoto, Japan
  • Rieko Sakai
    Department of Ophthalmology, Kyoto Prefectural Univ of Medcine, Kyoto City Kamigyoku, Kyoto, Japan
  • Mengxi Niu
    Department of Ophthalmology, Kyoto Prefectural Univ of Medcine, Kyoto City Kamigyoku, Kyoto, Japan
  • Akihide Watanabe
    Department of Ophthalmology, Kyoto Prefectural Univ of Medcine, Kyoto City Kamigyoku, Kyoto, Japan
  • Shigeru Kinoshita
    Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural Univ of Medicine, Kyoto, Japan
  • Chie Sotozono
    Department of Ophthalmology, Kyoto Prefectural Univ of Medcine, Kyoto City Kamigyoku, Kyoto, Japan
  • Footnotes
    Commercial Relationships   Hiroaki Kato, None; Norihiko Yokoi, Kowa (P); Rieko Sakai, None; Mengxi Niu, None; Akihide Watanabe, None; Shigeru Kinoshita, Kowa (P); Chie Sotozono, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 2862. doi:
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      Hiroaki Kato, Norihiko Yokoi, Rieko Sakai, Mengxi Niu, Akihide Watanabe, Shigeru Kinoshita, Chie Sotozono; Effect of punctal occlusion on blinks in eyes with severe aqueous tear deficient dry eye. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2862.

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      © 2017 Association for Research in Vision and Ophthalmology.

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Abstract

Purpose : It is considered that tear-film instability and increased friction during blinking are related to the pathophysiology of severe aqueous-tear-deficient dry eye (SATD). Punctal occlusion (PO) is considered to improve both of the above mechanisms by stabilizing the tear film and reducing the blink-related friction via the increase of the tear volume over the ocular surface. Accordingly, PO may affect blinks. The purpose of the present study was to investigate the effect of PO on blinks.

Methods : This study involved 16 eyes of 16 SATD patients (2 males and 14 females, mean age: 65.7 years, mean Schirmer I test score: 2.5mm/5 minutes). In all eyes, tear meniscus radius (TMR, mm), spread grade (SG) of the tear-film lipid layer (i.e., SG 1-5: 1 being the best), fluorescein breakup time (FBUT, seconds), ocular-surface epithelial damage score (OSED, cornea: 15 points maximum, conjunctiva: 6 points maximum), corneal filament grade (CF: 3 points maximum), lid-wiper epitheliopathy grade (LWE: 6 points maximum) and superior limbic keratoconjunctivitis grade (SLK: 3 points maximum) were evaluated before and at more than 1-month after PO. Moreover, by the use of a custom-made high-speed blink analyzer, palpebral aperture height (PAH, mm), blink rate (BR, per minute), ascending/descending distance (AD/DD, mm) of the upper eyelid, ascending/descending time (AT/DT, millisecond) of the upper eyelid, and maximum ascending/descending velocity (MAV/MDV, mm/second) of the upper eyelid were measured at the same time point.

Results : TMR, SG, FBUT, OSED (cornea), CF, LWE, and SLK were significantly improved after PO (all p<.03). DD, AD, MDV, and MAV increased significantly after PO (all p<.04). Significant correlations were found between ΔDD and ΔOSED (cornea), ΔAD and ΔSG, ΔAD and ΔOSED (cornea), ΔMDV and ΔTMR, ΔMDV and ΔCF, and ΔMAV and ΔCF (R= -0.54~-0.64, p<.03).

Conclusions : The findings of this study suggest that in eyes with SATD, PO effectively improves ocular surface abnormalities related not only to the tear-film instability but also to the blink-related friction via the increase of tear volume, and this may also result in an alteration in the blink.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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