Management of Severe Dry Eye Patients for Improving Their Quality of Life before Obtaining Complete Surgical Punctal Occlusion

Abstract

Abstract: : Purpose: The quality of life (QOL) of severe dry eye patients is remarkably deteriorated because of strong foreign body sensation. The present study aimed to evaluate the efficacy and safety of the management for severe dry eye patients using higher water-content disposable contact lens and frequent application of non-preserved artificial tears. Methods: Four severe dry eye patients (age: 28-61 yrs; two males, two females; one graft versus host disease, one Stevens-Johnson syndrome, two Sjögren’s syndrome) who experienced repeated surgical punctual occlusion but had still incomplete occlusion assigned to this study. All cases had strong foreign body sensation due to the severe superficial punctate keratopathy and/or filamentary keratitis and agreed with starting the treatment with higher water-content disposable contact lens and frequent application of non-preserved artificial tears. Subjective symptoms and corneal fluorescein staining were evaluated before and after the treatment. Specular microscopy of corneal epithelium was performed after contact lens wear. Results: Subjective symptoms improved remarkably and superficial punctate keratopathy and filamentary keratitis disappeared. No complications were recorded (average observation period was 190.3 days). Specular microscopy disclosed that healthy epithelial cell appearance with bright, intermediate and dark cells, but with increased cell size were maintained. Conclusions: Combination of higher water-content disposable contact lens and frequent application of non-preserved artificial tears can be a useful management to improve QOL in severe dry patients until obtaining complete surgical punctual occlusion.

Keywords: cornea: tears/tear film/dry eye • contact lens • clinical (human) or epidemiologic studies: tre