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Jessica Schonfeld, Jay Pepose, Mujtaba Qazi; The Influence of Punctal Occlusion on Osmolarity in Dry Eye Subjects. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6024.
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To determine the influence of punctal occlusion on tear film osmolarity in dry eye disease subjects using Tear Lab Osmometry.
This is a single-site clinical pilot study of tear osmolarity using the TearLab Osmolarity System in dry eye disease subjects who are being treated with punctal occlusion using Odyssey Parasol occluders. All subjects were assessed at 3 visits: an initial enrollment visit, and a 1-week and 1-month visit. Subjects were recruited to receive punctal plug occlusion at the initial visit if the baseline tear osmolarity was over 308 mOsm/L. At each visit, tear osmolarity of both eyes was measured using the TearLab Osmometer. A subjective questionnaire regarding severity and frequency of dry eye symptoms was collected at each visit. Corneal and conjunctival staining, tear break-up time and meibomian dysfunction were also graded on a standardized scale.
Mean tear osmolarity decreased from a baseline value of 330 +/-10.4 mOsm/L to 318 +/- 12.3 mOsm/L at Visit 2 (p=0.038) and 310 +/- 11.0 mOsm/L at Visit 3 (p=0.009) after punctal occlusion with punctal plugs. Tear break-up time also increased from a baseline value of 4.4 +/- 1.5 seconds to 6.4 +/- 2.5 seconds at Visit 2 and 8.4 +/- 2.4 seconds at Visit 3, reaching statistical significance at Visit 3 (p =.0007.) Corneal/conjunctival staining decreased from a mean baseline value of 1 +/- 1.2 to 0.5 +/- 0.85 at Visit 2 (p=0.015) and 0.4 +/- 0.52 at Visit 3 (p=0.024.)
After punctal occlusion, tear osmolarity and conjunctival/corneal staining showed a statistically significant reduction and tear break-up time demonstrated a statistically significant increase. Tear hyperosmolarity is regarded as a hallmark of dry eye disease, and tear osmometry stands as a promising diagnostic test to monitor the clinical efficacy of dry eye therapies such as punctal occlusion.
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