PURPOSE. To investigate and compare the effects of superior and inferior silicone punctal occlusion in hydrogel contact lens wearers with dry eye signs and symptoms. METHOD. An 8 week, prospective, placebo-controlled study design was followed. A total of 10 subjects, 8 females and 2 males, were recruited based on specific signs and symptoms of dry eye with hydrogel contact lens wear. Tear film break-up time (TBUT), tear-production, fluorescein and lissamine-green staining were monitored throughout the study as were the symptoms of dryness, lens awareness and blur. After baseline levels of these signs and symptoms were established, one previously randomized eye was chosen to serve as the treatment eye, with the other eye serving as a control. Both superior and inferior silicone punctal occlusion were performed separately in the treatment eye, with a washout period being employed between treatment methods.
RESULTS. Both superior and inferior punctal occlusion diminish the symptoms associated with dry eye in hydrogel contact lens wearers. Direct statistical comparisons, however, show that neither treatment method is more effective in reducing these symptoms. Superior occlusion may be more effective in reducing fluorescein corneal staining and lissamine green bulbar staining. TBUT, tear production, fluorescein bulbar staining, and lissamine green corneal staining appear to be unaffected by either method.
CONCLUSIONS. Superior and inferior punctal occlusion appear to be equivalent in their ability to diminish the signs and symptoms associated with dry eye in hydrogel contact lens wearers. If similar studies performed on a larger scale confirm these findings, then standard of care would simply require an evaluation eyelid anatomy and occlusion of those puncta least likely to irritate the bulbar conjunctiva and cornea.