PURPOSE. It has been suggested that inserting punctal plugs into the upper puncta rather than the lower puncta will provide equal dry eye symptom relief while reducing the risk of the patient experiencing epiphora. The present study examines this hypothesis. METHOD. Twenty subjects with symptomatic dry eye who were considered candidates for punctal occlusion based on Schirmer test results were included in this study. The subjects, fifteen females and five males ranged in age from 23 to 60 years with a mean age of 28.35 years. Prior to punctal plug insertion a TBUT, Rose Bengal staining and Schirmer test were performed. Selection of the puncta to be occluded was based on the subjects enrollment number. The odd number subjects had the upper right and lower left puncta occluded while the even number subjects had the upper left and lower right puncta occluded. One week after insertion, the subjects were retested as before and given a comfort questionnaire.
RESULTS. Sixteen subjects were able to complete the study. The four remaining subjects were discontinued secondary to mechanical irritation. Ten of the sixteen subjects who completed the study reported the eye with the lower puncta occluded felt better than the eye with the upper puncta occluded. The remaining six subjects said both eyes felt better but did not appreciate any difference between eyes. None of the subjects reported the eye with the upper puncta occluded felt better. Only two subjects had epiphora, one had upper occlusion while the other had lower occlusion. Three subjects had improvement in Rose Bengal staining after occlusion. The TBUT increased slightly from 4.1 seconds pre-insertion to 4.41 seconds post-insertion. No improvement in Schirmer test was noted.
CONCLUSIONS. Based on the results of this study, it does not appear that occlusion of the upper puncta provides any better symptom relief or is less likely to cause epiphora than occlusion of the lower puncta.