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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. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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).
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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