A clinical procedure to predict the value of temporary occlusion therapy in keratoconjunctivitis sicca

Purpose: To evaluate the effects of dissolvable collagen punctal plugs on the symptoms, tear stability and volume in aqueous deficient dry eyes. Methods: Sixty-two aqueous deficient dry eye patients of mixed aetiology underwent lacrimal punctal occlusion with dissolvable collagen plugs. The subjects were randomly allocated to one of two treatment groups: group I (n = 36) had their lower puncta occluded and group II (n = 26) had both their upper and lower puncta occluded. The effectiveness of this treatment was clinically assessed by (1) scoring subject symptoms and (2) measuring the tear parameters of tear thinning time (TTT) and tear meniscus height (TMH) as indicators of tear stability and volume, respectively. Following baseline measurements, patients were reviewed at time intervals of 5 and 12 days post-occlusion. A group of age- and gender-matched normals (n = 45) was recruited for comparison (group III). Results: Tear volume and stability were significantly higher in group III compared with I and II at baseline. In the treated groups on both days 5 and 12: (1) symptom score reduced significantly from a median value of 7 to 3 (p < 0.001); (2) tear stability increased significantly from a median value of 3 to 5 s by day 5 (p less than or equal to 0.001); reduced between days 5 and 12 (p < 0.05) and remained below the stability in group III at all times; (c) tear volume increased significantly by day 5 in both treatment groups from a median value of 0.13 to 0.20 mm (p less than or equal to 0.001), remained stable by day 12 in group II but reduced in group I (p < 0.05); (d) the increase in tear volume was negatively correlated with pretreatment tear volume; (e) symptom score correlated with both baseline tear volume and stability. Conclusion: Collagen plugs improved tear status in the aqueous deficient dry eyes. Occluding both upper and lower puncta with temporary collagen plugs offers no practical beneficial gain compared with occluding just the lower punctum.