Comparative study between thermo- sensitive hydrophobic acrylic versus silicone punctal plugs therapy for dry eye

Abstract

Dry eye syndrome is an extremely common and often disabling ocular condition afflicting millions of citizens. Although recently there has been an enhanced recognition of the prevalence of this condition, there is still a dearth of data on its epidemiology, associated economic costs, and the long –term efficacy of currently available treatment modalities. Iatrogenic occlusion of the lacrimal drainage system with plugs is the second most frequent method of treating the dry eye as plugs is usually easier to reserve than surgical approaches and are easy to insert and monitor. It preserves natural tears or prolongs the retention time of artificial tears on the ocular surface and can substantially improve the quality of life of patients by relief of symptoms and maintain the integrity of ocular surface and visual acuity in moderate /severe dry eye. In the present study it was found that the use of smart plugs and silicone punctual plugs can be an effective step in the management of moderate to severe dry eye that is unresponsive to topical lubricant therapy alone. In the present study 90 eyes of 45 patients of moderate and severe dry eye after proper case selection , were subjected to acrylic (smart plug) inserted in the lower punctum of one eye and the other eye subjected to silicone plug and were subjected to careful history taking and opthalmological examination . Fluorescein tear break –up time, Schirmer's test with topical anathesia , corneal surface integrity by rose bengal and fluorescein vital staining of Summary 197 ocular surface and finally , conjunctival impression cytology were subjected to the patients before plug insertion and 1month, 3months and 6 months after plug insertion. The present study found that, there were no improvement in the patients' symptoms scores and also the vital stains after 1month to 3months, there were gradual improvement from 3 months up to 6 months post insertion in both the acrylic hydrophobic and the silicone plugs patients. As regard the symptoms score both types shown similar significant improvement only 3 months post plug insertion but after 6 months, we found that acrylic thermosensitive plug has significant higher effect than the silicone plugs. This study found that both the acrylic thermo-sensitive ( Smart plug ) and the conventional (Silicone plug) increased aqueous tear volume and thus resulting in objective and subjective recovery in all cases thus the efficacy of the two types of plugs was similar in short- term follow up ( after 3 months and before 6 months ), but with long term, the complications with poor reliability of the patients also with high loss associated with the use of silicone plug , makes the acrylic thermosensitive plug more effective both in objective and subjective outcome. As regard to the special tests , the present study found significant improvement of TBUT , Schirmer’s test values , ocular surface staining with rose bengal and flurosceine , conjunctival impression cytology specially the degree of keratinization in comparison to pretreatment results and the improvement mostly occurred 6 months post-plug insertion as most the study cases suffering from moderate and severe dry eye.