The treatment of severe trachomatous dry eye with canalicular silicone plugs

Purpose To evaluate the effects of temporary canalicular occlusion with sil icone plugs on trachomatous dry eye patients who were on maximal tolerable medical therapy. Methods Forty-four trachomatous dry eye patients who had Schirmer testing w ith topical anaesthetic measuring 5 mm or less and a tear film break-up tim e of 5 s or less were included. After the lacrimal efficiency test with dis solvable collagen punctal plugs, silicone canalicular plugs were placed in 22 trachomatous dry eye patients. The other 22 patients in the untreated co ntrol group were allowed to continue their medical therapy. Pretreatment an d post-treatment evaluations included subjective patient assessment, rose B engal and fluorescein staining, tear film break-up time, Schirmer testing, conjunctival impression cytology and goblet cell counting. Results Six months after plug placement, 18 eyes (82%) of 22 patients had s ubjective improvement and all these patients successfully wore plugs for at least 6 months. There were statistically significant differences between t he pretreatment and post-treatment test results including rose Bengal and f luorescein staining scores, tear film break-up times and Schirmer testing m easurements. Impression cytology showed improvement of squamous metaplasia in 17 eyes (77%). Eight of the patients (36%) were able to decrease depende ncy on topical therapy. Ten of the patients (45%) completely stopped using artificial tears. There were statistically significant differences between the two groups in the total symptom scores, staining scores, tear film brea k-up time, Schirmer testing, impression cytology scores and goblet cell cou nts. Conclusion In cases where topical tear supplementation is insufficient to r elieve the signs and symptoms of severe dry eye and the lacrimal puncta hav e not already been closed by the trachomatous cicatrising process, occlusio n of the canaliculi may be useful to prevent drainage of both natural and a rtificial tears. Canalicular occlusion improves the objective signs and sub jective symptoms and may significantly decrease dependency on tear suppleme nts in selected patients.