September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Effects of punctal occlusion on tear protein levels in dry eye patients
Author Affiliations & Notes
  • Louis Tong
    Singapore National Eye Centre, Singapore, Singapore
  • Lei Zhou
    Singapore National Eye Centre, Singapore, Singapore
  • Roger W Beuerman
    Singapore National Eye Centre, Singapore, Singapore
  • Susan Simonyi
    Allergan plc, Irvine, California, United States
  • David A Hollander
    Allergan plc, Irvine, California, United States
  • Michael E Stern
    Baylor College of Medicine, Mission Viejo, California, United States
  • Footnotes
    Commercial Relationships   Louis Tong, None; Lei Zhou, None; Roger Beuerman, Allergan (C); Susan Simonyi, Allergan (E); David Hollander, Allergan (E); Michael Stern, Allergan (E)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, No Pagination Specified. doi:
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      Louis Tong, Lei Zhou, Roger W Beuerman, Susan Simonyi, David A Hollander, Michael E Stern; Effects of punctal occlusion on tear protein levels in dry eye patients. Invest. Ophthalmol. Vis. Sci. 2016;57(12):No Pagination Specified.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Proteins play an important role in the ocular surface microenvironment and tear protein dysregulation has been observed in dry eye disease. We previously demonstrated that punctal occlusion commonly used to improve dry eye symptoms does not significantly alter cytokine levels, and baseline Schirmer’s score was the most important factor associated with tear cytokine levels. Here, we explored global tear protein levels in dry eye patients at baseline and after occlusion.

Methods : In this prospective, longitudinal, single-center study, 30 patients with moderate dry eye had non-absorbable punctal plugs inserted bilaterally in lower puncta. In the more severe eye, global dry eye symptoms scores, fluorescein corneal staining, Schirmer’s I test, tear film break-up time (TBUT) and safety were assessed at baseline, week 1 and week 3. Proteins in tear samples collected using Schirmer’s test strips were quantified and compared relative to preocclusion baseline levels using isobaric tagging for relative and absolute quantification (iTRAQ) and nano-liquid chromatography-tandem mass spectrometry (nanoLC-MS/MS).

Results : Twenty nine patients (mean age 49.7 years) completed the study; mean (SD) baseline global irritation symptoms score 53.8 (26.5), Schirmer’s score 5.1 (2.8) mm, and TBUT 2.2 (0.6) seconds. Levels of more than 400 tear proteins were analyzed from 23 patients with sufficient tear samples. Hierarchical clustering analysis based on 94 proteins with <20% missing values revealed two distinct tear protein clusters: cluster 1 characterized by inflammatory-related proteins (eg, S100A8, S100A9); cluster 2 characterized by lacrimal supportive proteins (eg, lysozyme, lacritin, prolactin-inducible protein). After 1 week occlusion, 5 patients showed improvement with decreased levels of inflammatory-related proteins and increased levels of lacrimal supportive proteins, whereas after 3 weeks occlusion, 10 patients had a positive response while 13 patients were unresponsive. Logistic regression analysis revealed that these 10 patients had significantly lower baseline Schirmer’s scores compared to the 13 non-responding patients (mean [SD]: 4.3 [1.3] vs 6.8 [2.6]; P=0.006).

Conclusions : Low Schirmer’s score at baseline is associated with a higher inflammatory tear protein profile. Patients with dry eye who do not response to punctal occlusion may require other treatments, such as anti-inflammatory agents, for management of their disease.

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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