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http://www.revoptom.com/content/c/20600/
VOLUME 2, NUMBER 14
AUGUST 8, 2011

PUNCTAL OCCLUSION CAN BE ONE OF THE MOST EFFECTIVE WAYS TO TREAT DRY EYE.
The Parasol Punctal Occluder System. (Image courtesy: Odyssey Medical.) Click here to view larger image.
Ever since the members of the Delphi Dry Eye Panel and the Dry Eye WorkShop (DEWS) indicated that inflammation should be controlled prior to the insertion of punctal plugs in dry eye patients, eye care providers have become more apprehensive to employ punctal occlusion early in the treatment regimen. To date, however, punctal occlusion remains one of the best dry eye treatments available for many patients. And although I agree that inflammation should be treated with a corticosteroid (e.g., Lotemax [loteprednol etabonate ophthalmic suspension, Bausch + Lomb]) and/or cyclosporine A (e.g., Restasis [cyclosporine ophthalmic, Allergan]) prior to punctal plug insertion, I still believe that the technique is underutilized and should be considered soon after the initiation of therapeutic management in symptomatic dry eye patients.

Furthermore, there are several instances when punctal occlusion should be considered a first-line dry eye treatment. Some examples include:
  • Neurotrophic dry eye or neurotrophic keratitis. Clinically, it appears that these patients respond quickly to punctal occlusion. This is likely because the ocular surface is neurotrophic, with low levels of inflammation.
  • Exposure keratopathy. Patients with lagophthalmos, incomplete blink, previous cosmetic lower lid surgery, lid laxity and early ectropion or entropion typically benefit from increased tear volume secondary to punctal plug insertion. Following occlusion, new tears often will begin to cover the lower corneal areas and help repair any existing damage on the inferior epithelium.
  • Post-LASIK dry eye. Although this condition usually is temporary (one to three months following surgery), post-LASIK patients often exhibit a slightly neurotrophic ocular surface that can be managed swiftly with punctal occlusion.
  • Early contact lens-induced dry eye. Contact lens patients with mild dry eye also seem to respond well to punctal occlusion. Perhaps there is less inflammation in the early stages and simply an osmolarity change or incomplete tear coverage. Either way, these patients also seem to be good candidates for treatment with punctal occlusion alone or in combination with therapeutic agents.
http://www.revoptom.com/content/c/20600/

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