Efficacy of Punctal Occlusion in Management of Dry Eyes after Laser<i>In Situ</i>Keratomileusis for Myopia

Alfawaz, Abdullah M.; Al-Gehedan, Saeed; Jastaneiah, Sabah; Al-Mansouri, Samir; Mousa, Ahmed; Al-Assiri, Abdullah

doi:10.3109/02713683.2013.841258

Cited by 24 publications

(15 citation statements)

References 22 publications

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“…Alfawaz et al [24] evaluated the effect of punctal plug use in preventing dry eyes after LASIK by comparing the results of the TBUT test, Schirmer’s test and OSDI in both eyes of the same patient treated with a lower punctal plug in one eye and using the other eye as control. They concluded that insertion of punctal plugs was significantly effective in improving dry eye symptoms and patient satisfaction after LASIK.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Botulinum Toxin A Injection and Lacrimal Punctal Plugs for the Control of Post-LASIK Dry Eye Manifestations: A Prospective Study

Fouda

Mattout

2017

Ophthalmol Ther

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IntroductionLaser in situ keratomelieusis (LASIK) is one of the commonest refractive procedures performed nowadays. The dry eye problem is nearly universal in all patients after LASIK and it can be so annoying that the post-operative patient satisfaction is sometimes precluded. Conventional treatment includes the use of artificial tears. Alternative methods such as punctal plugs and botulinum toxin injection can be used for the management of post-LASIK dry eye. The aim of this study is to compare botulinum toxin injection in the orbicularis muscle to lacrimal punctal plugs for the control of post-LASIK dry eye manifestations.MethodsThis is a prospective study that included 60 patients who had LASIK eye surgery for correction of refractive errors. Patients were randomly assigned to one of three methods of dry eye management; the first method was conventional medical treatment with preservative-free tear substitutes only (group A: 20 patients = 40 eyes); the second method was intraoperative injection of botulinum toxin A (BTA) in the orbicularis muscle below the lower punctum of both eyes (group B: 20 patients = 40 eyes) and the third method was intraoperative insertion of temporary extended duration silicone punctal plugs in the lower punctum of both eyes (group C: 20 patients = 40 eyes).ResultsIn the first follow-up visit after 2 weeks, the two test groups (B, C) showed a statistically significant increase in both tear film break up time (TBUT) and Schirmer test score with a decrease in the OSDI score and daily frequency of lubricants used in comparison to the control group A. These differences were maintained in the next follow-up visit but they became statistically insignificant at the 3rd and 6th post-operative months. Complications were encountered more in the punctal plug patients (60%) than in BTA patients (25%) and this difference was statistically significant.ConclusionThe use of BTA injection to control dry eye symptoms by inducing temporary punctal ectropion is an effective method to improve patient satisfaction after LASIK eye surgery. It has higher level of patient satisfaction and fewer complications in comparison to punctal plugs or topical standard dry eye treatment.

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Section: Discussionmentioning

confidence: 99%

Comparison Between Botulinum Toxin A Injection and Lacrimal Punctal Plugs for the Control of Post-LASIK Dry Eye Manifestations: A Prospective Study

Fouda

Mattout

2017

Ophthalmol Ther

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“…While the pathophysiology of this complication is still evolving, a number of theories have been proposed to explain why dry eye occurs following refractive surgery, including exacerbation of preexisting dry eye disease [ 12 ], medicamentosa from postoperative medications [ 19 , 20 ], and damage to conjunctival goblet cells increasing tear hyperosmolarity and inflammation [ 19 , 21 – 23 ]. The interaction between the ocular surface and eyelids is an important factor in maintaining tear production and flow, which is also altered following surgery [ 10 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Dry Eye Disease following Refractive Surgery: A 12-Month Follow-Up of SMILE versus FS-LASIK in High Myopia

Wang

Naidu

Chu

et al. 2015

Journal of Ophthalmology

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Purpose. To compare dry eye disease following SMILE versus FS-LASIK. Design. Prospective, nonrandomised, observational study. Patients. 90 patients undergoing refractive surgery for myopia were included. 47 eyes underwent SMILE and 43 eyes underwent FS-LASIK. Methods. Evaluation of dry eye disease was conducted preoperatively and at 1, 3, 6, and 12 months postoperatively, using the Salisbury Eye Evaluation Questionnaire (SEEQ) and TBUT. Results. TBUT reduced following SMILE at 1 and 3 months (p < 0.001) and at 1, 3, and 6 months following FS-LASIK (p < 0.001). TBUT was greater following SMILE than FS-LASIK at 3, 6, and 12 months (p < 0.001, p < 0.001, and p = 0.009, resp.). SEEQ scores increased (greater symptoms) following SMILE at 1 month (p < 0.001) and 3 months (p = 0.003) and at 1, 3, and 6 months following FS-LASIK (p < 0.001). SMILE produced lower SEEQ scores (fewer symptoms) than FS-LASIK at 1, 3, and 6 months (p < 0.001). Conclusion. SMILE produces less dry eye disease than FS-LASIK at 6 months postoperatively but demonstrates similar degrees of dry eye disease at 12 months.

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“…In another study, 86% patients were free of symptoms of dry eye at 6-month follow-up and 76% of patients had stopped using lubricants after punctal occlusion with silicone punctal plugs [ 32 ]. Punctal occlusion is effective in treating many conditions that cause dry eyes such as Stevens-Johnson syndrome, keratoconjunctivitis sicca, contact lens wear, and superior limbic keratoconjunctivitis [ 33 ]. Another study evaluated canalicular occlusion with collagen and silicone plugs (Herrick plugs) in patients with dry eye related conjunctivitis.…”

Section: Methodsmentioning

confidence: 99%

“…Albietz et al reported that the use of lubricants and other options such as punctal plugs before refractive surgery increased the postprocedure goblet cell density [ 44 ]. A prospective randomized clinical trial evaluated punctal occlusion with punctal plugs after LASIK treatment for prevention of dry eye in 78 eyes of 39 patients [ 33 ]. Both eyes of the subjects underwent LASIK and lower punctal occlusion of one eye was performed while the other eye served as a control.…”

Section: Methodsmentioning

confidence: 99%

Comprehensive Review of the Literature on Existing Punctal Plugs for the Management of Dry Eye Disease

Jehangir

Bever

Mahmood

et al. 2016

Journal of Ophthalmology

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Numerous designs of punctal and canalicular plugs are available on the market. This variety presents challenges to ophthalmologists when choosing punctal plugs for the management of various ocular conditions. The aim of this literature review is to provide a classification system for lacrimal occlusive devices based on their location and duration of action as well as to identify different characteristics of each one of them. We want to give a comprehensive overview on punctal and canalicular plugs including their manufacturing companies, indications, and complications that have been reported in various articles. PubMed and Google Scholar were used to identify articles written in English as well as few articles written in Japanese, Chinese, Slovak, and Spanish that had abstracts in English. Nine different companies that manufacture punctal and canalicular plugs were identified and their plugs were included in this review. Punctal and canalicular plugs are used in the management of various ocular conditions including dry eye disease and punctal stenosis as well as in ocular drug delivery. Although they are a relatively safe option, associated complications have been reported in the literature such as infection, allergic reaction, extrusion, and migration.

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Efficacy of Punctal Occlusion in Management of Dry Eyes after LaserIn SituKeratomileusis for Myopia

Abstract: Punctal plug insertion after LASIK surgeries may minimize the need for frequent lubricant application and hence improve patient satisfaction.

Cited by 24 publications

References 22 publications

Comparison Between Botulinum Toxin A Injection and Lacrimal Punctal Plugs for the Control of Post-LASIK Dry Eye Manifestations: A Prospective Study

Comparison Between Botulinum Toxin A Injection and Lacrimal Punctal Plugs for the Control of Post-LASIK Dry Eye Manifestations: A Prospective Study

Dry Eye Disease following Refractive Surgery: A 12-Month Follow-Up of SMILE versus FS-LASIK in High Myopia

Comprehensive Review of the Literature on Existing Punctal Plugs for the Management of Dry Eye Disease

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