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David Eldridge, Michael Berg, Benjamin Sullivan, William Townsend; The Influence of Punctal Occlusion on Osmolarity in Dry Eye Subjects. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6048.
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Dry eye disease is a common and major source of disability and its onset may be triggered or modified by exposure to systemic drugs, contact lens wear, ocular surgery and adverse environmental and work conditions. Tear hyperosmolarity is central to the dry eye disease pathogenesis, and may serve as a valuable marker in the monitoring of disease severity. This study is designed to determine the variation in tear osmolarity over time using TearLab Osmometry in DED subjects being treated with punctal occlusion with punctal plugs.
Ten subjects (9F/1M, age=54.3±15.8 years), with tear osmolarity in one eye greater than 311 mOsm/L, were tested for tear osmolarity, symptoms (VAS), an eyelid exam under slit lamp, fluorescein staining of the cornea and conjunctiva, followed by a meibomian dysfunction assessment. Subjects refrained from administering any topical drug within two hours of measurement, and were excluded if they had any clinically significant eyelid deformity, previous ocular disease including infections, active allergy, LASIK or PRK surgery within one year of the study, abnormality of nasolacrimal drainage, previous punctal plugs or cauterization, diagnosis of a systemic disease or a change in chronic systemic medication known to affect tear production. Subjects were evaluated at three visits, including the initial screening, at intervals of approximately two weeks over the course of approximately 30 days. Research was conducted in compliance with the Declaration of Helsinki, all subjects completed informed consent prior to the study.
Tear osmolarity (316.9±6.2 to 304.8±16.0, p = 0.039), conjunctival staining (1.6±0.8 to 0.7±0.8, p=0.027), symptom frequency (4.8±2.2 to 2.0±1.5, p=0.004) and symptom severity (5.1±1.2 to 1.9±1.4, p<0.001) were significantly reduced from the first to the third visit. Corneal staining, eyelid evaluation grading and meibomian gland function were unchanged over the study period. 70% of the subjects had their osmolarity reduced below 308 mOsm/L, while 30% were classified as non-responders.
Preliminary results suggest that punctal plugs are an effective method for reducing frequency and severity of symptoms, tear osmolarity and conjunctival staining in mild to moderate dry eye disease.
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