Lacrimal Punctum Occlusion in the Treatment of Severe Keratoconjunctivitis Sicca Caused by Sjögren Syndrome

Mansour, Khaled; Leonhardt, Carolien J.; Kalk, W; Bootsma, Hendrika; Bruin, K.J.; Blanksma, Lieuwe J.; null, null

doi:10.1097/01.ico.0000244877.30997.6a

Cited by 37 publications

(58 citation statements)

References 21 publications

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“…In all of these patients complete or nearly complete resolution of all symptoms and objective findings was achieved. Mansour et al 15 examined lacrimal punctal occlusion in patients suffering from KCS due to Sjö gren's syndrome, which has similar pathophysiological mechanisms to ocular GvHD, and consistent with our findings showed a significant subjective and objective improvement of dry eye manifestation in these patients. One may hypothesise that the larger the amount of tears present, the proinflammatory cytokines may become more diluted.…”

Section: Discussionsupporting

confidence: 67%

Punctal occlusion is safe and efficient for the treatment of keratoconjunctivitis sicca in patients with ocular GvHD

Sabti

Halter

Fränkl

et al. 2011

Bone Marrow Transplant

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The use of punctal plugs in the treatment of keratoconjunctivitis sicca (KCS) in inflammatory eye disease remains controversial because of the potentially increased retention time of tears enriched with inflammatory cytokines that may aggravate eye inflammation. We describe the safety and efficacy of punctal occlusion in a retrospective analysis of 19 patients (16 men) with KCS due to chronic GvHD (cGvHD). Efficacy and safety were assessed by subjective and objective criteria (symptoms, corneal fluorescein staining, tear film break-up time (BUT), Schirmer I test, Jones test and visual acuity). Follow-up was from plug insertion until maximum one year after punctal occlusion. After punctal occlusion, patients reported a significant increase in subjective comfort (1.10 vs 0.59 on a scale ranging from no symptoms (0) to severe impairment (2), Po0.001). Pathological corneal fluorescein staining decreased significantly (Po0.001) and tear film BUT remained unchanged (5.98 vs 4.0 s, P ¼ 0.79). Measurement of tear secretion or retention time showed a non-significant trend for improvement in the Schirmer I (3.0 vs 3.40 mm, P ¼ 0.08) and Jones (1.36 vs 2.8 mm, P ¼ 0.08) tests. The logMAR visual acuity remained unchanged. Punctal occlusion achieved a significant improvement in subjective symptoms and objective findings in ocular GvHD without increasing ocular inflammation.

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Section: Discussionsupporting

confidence: 67%

Punctal occlusion is safe and efficient for the treatment of keratoconjunctivitis sicca in patients with ocular GvHD

Sabti

Halter

Fränkl

et al. 2011

Bone Marrow Transplant

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“…2 for Risk of Bias Table. Sequence generation was judged to be at low risk of bias for two studies [32,33] that used computer-generated randomization schemes. The method of sequence generation was not discussed in the remaining three included studies [29 31].…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

“…These included the following clinician-reported outcomes ofunstimulated salivary flow over 10 min [30 33] and over 15 min [30] and paraffin-stimulated salivary flow over 5 min [30]. Further clinician-reported assessments of ocular dryness included tear gland function tests, including Schirmer's test [32,33], the Rose Bengal test, mucus debris in the cul-de-sac [32], tear break-up time [33], ocular contrast sensitivity, glare disability and corneal fluorescein staining [33]. Further physicianreported oral dryness measures included the user of a 1 13 clinical dryness scale [31], an oral bacteriological sample and periodontal measurements (pocket depth, plaque and bleeding) [31].…”

Section: Participantsmentioning

confidence: 99%

“…Further physicianreported oral dryness measures included the user of a 1 13 clinical dryness scale [31], an oral bacteriological sample and periodontal measurements (pocket depth, plaque and bleeding) [31]. Participant-reported outcome measures for dryness included discomfort from mouth dryness, eye dryness, tongue and mouth burning [10-point visual analogue scale (VAS)] [30] and subjective ocular discomfort [32].…”

Section: Participantsmentioning

confidence: 99%

“…One of the studies on punctum plugs reported spontaneous plug extrusion in 28% of the participants [32].…”

Section: Participantsmentioning

confidence: 99%

See 2 more Smart Citations

204. A Systematic Review of Non-Pharmacological Interventions for Primary Sjögren’s Syndrome

Hackett¹,

Deane

Deary

et al. 2014

Rheumatology

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Objective. To evaluate the effects of non-pharmacological interventions for primary SS (pSS) on outcomes falling within the World Health Organization International Classification of Functioning Disability and Health domains.Methods. We searched the following databases from inception to September 2014: Cochrane Database of Systematic Reviews; Medline; Embase; PsychINFO; CINAHL; and clinical trials registers. We included randomized controlled trials of any non-pharmacological intervention. Two authors independently reviewed titles and abstracts against the inclusion/exclusion criteria and independently assessed trial quality and extracted data.Results. A total of 1463 studies were identified, from which 17 full text articles were screened and 5 studies were included in the review; a total of 130 participants were randomized. The included studies investigated the effectiveness of an oral lubricating device for dry mouth, acupuncture for dry mouth, lacrimal punctum plugs for dry eyes and psychodynamic group therapy for coping with symptoms. Overall, the studies were of low quality and at high risk of bias. Although one study showed punctum plugs to improve dry eyes, the sample size was relatively small. Conclusion.Further high-quality studies to evaluate non-pharmacological interventions for PSS are needed.

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Punctal occlusion for dry eye syndrome

Ervin¹,

Wojciechowski²,

Schein³

2007

Cochrane Database of Systematic Reviews

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Background-Dry eye syndrome is a disorder of the tear film and is associated with symptoms of ocular discomfort. Punctal occlusion is a mechanical treatment in which the tear drainage system is blocked in order to aid in the preservation of natural tears on the ocular surface. Objectives-The objective of this review was to assess the safety and efficacy of punctal plugs for the management of dry eye.

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Lacrimal Punctum Occlusion in the Treatment of Severe Keratoconjunctivitis Sicca Caused by Sjögren Syndrome

Abstract: Punctum occlusion therapy in a short-term study improved the rose Bengal score and discomfort score in our patients and thus may be helpful in the treatment of severe dry eye caused by Sjögren syndrome.

Cited by 37 publications

References 21 publications

Punctal occlusion is safe and efficient for the treatment of keratoconjunctivitis sicca in patients with ocular GvHD

Punctal occlusion is safe and efficient for the treatment of keratoconjunctivitis sicca in patients with ocular GvHD

204. A Systematic Review of Non-Pharmacological Interventions for Primary Sjögren’s Syndrome

Punctal occlusion for dry eye syndrome

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