Abstract
To compare the effects of treatment with punctal plugs versus artificial tears on visual function for primary Sjögren’s syndrome with dry eye. Forty-two eyes of 42 patients with primary Sjögren’s syndrome were enrolled and were allocated randomly into artificial tears (AT) group and punctal plugs (PP) group. Ocular Surface Disease Index (OSDI) was used, and fluorescent staining for tear film break-up time (BUT), the Schirmer test I (STI) and contrast sensitivity was performed before treatment and was repeated 3 months after treatment. A follow-up of 3 months was achieved in 40 eyes of 40 patients, including 19 eyes in artificial tears group and 21 eyes in punctal plugs group. Statistically significant improvements were observed in the OSDI scores (AT: 52.6 ± 5.7, 15.9 ± 4.2; PP: 55.8 ± 4.9, 15.1 ± 4.2), corneal fluorescein staining scores (AT: 2.60 ± 1.76, 0.30 ± 0.57; PP: 1.91 ± 1.60, 0.09 ± 0.29), STI (AT: 3.85 ± 2.03, 8.95 ± 2.72; PP: 3.36 ± 1.62, 11.41 ± 2.65), and BUT (AT: 2.60 ± 1.39, 6.00 ± 1.81; PP: 2.27 ± 1.12, 7.82 ± 1.84) after treatment compared to those of pre-treatment. The values of STI (AT: 5.10 ± 1.80; PP: 8.05 ± 1.53) and BUT (AT: 3.40 ± 1.31; PP: 5.68 ± 1.13) in punctal plugs group were significantly more improved than those in the artificial tears group. The medium- and high-level frequencies contrast sensitivities were greatly improved in simulated daylight, night, and glare disability conditions after treatment with artificial tears and punctal plugs. However, the changes in contrast sensitivity did not significantly differ between groups. Both artificial tears and punctal plugs relieved dry eye symptoms, repaired corneal lesions, enhanced tear film stability, and improved contrast sensitivity. Punctal plugs could improve tear film stability and elongate the BUT better than artificial tears.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gayton JL (2009) Etiology, prevalence, and treatment of dry eye disease. Clin Ophthalmol 3:405–412
Huang FC, Tseng SH, Shih MH, Chen FK (2002) Effects of artificial tears on corneal surface regularity contrast sensitivity and glare disability. Ophthalmology 109:1934–1940
Liu Z, Pflugfelder SC (1999) Corneal surface regularity and the effect of artificial tears in aqueous tear deficiency. Ophthalmology 106:939–943
Torkildsen G (2009) The effects of lubricant eye drops on visual function as measured by the Inter-blink interval visual acuity decay test. Clin Ophthalmol 3:501–506
Goto E, Yagi Y, Kaido M, Matsumoto Y, Konomi K et al (2003) Improved functional visual acuity after punctal occlusion in dry eye patients. Am J Ophthalmol 135:704–705
Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexan-der EL, Carsons SE et al (2002) Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 61(6):554–558
Walt J (2004) Ocular surface disease index (OSDI) administration and scoring manual. Allergan, Inc., Irvine
Schiffman RM, Christianson MD, Jacobsen G et al (2000) Reliability and validity of the ocular surface disease index. Arch Ophthalmol 118:615–621
Prabhasawat P, Tseng SCG (1998) Frequent association of delayed tear clearance in ocular irritation. Br J Ophthalmol 82:666–675
Pflugfelder SC, Tseng SCG, Sanabria O et al (1998) Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea 17:38–56
Toda I, Asano-Kato N, Komai-Hori Y, Tsubota K (2001) Dry eye after laser in situ keratomileusis. Am J Ophthalmol 132:l–l7
Dursun D, Monroy D, Knighton R, Tervo T, Vesaluoma M, Carraway K et al (2000) The effects of experimental tear film removal on corneal surface regularity and barrier function. Ophthalmology 107:1754–1760
Egrilmez Sait, Aslan Fatih, Karabulut Gonca, Kabasakal Yasemin, Yagci Ayse (2011) Clinical efficacy of the smartplug™ in the treatment of primary Sjögren’s syndrome with keratoconjunctivitis SICCA: one-year follow-up study. Rheumatol Int 31:1567–1570
Rieger G (1992) The importance of the precorneal tear film for the quality of optical imaging. Br J Ophthalmol 76:157–158
Rieger G (1993) Contrast sensitivity in patients with keratoconjunctivitis sicca before and after artificial tear application. Graefes Arch Clin Exp Ophthalmol 231:577–579
Rolando M, Iester M, Macri A, Calabria G (1998) Low spatial-contrast sensitivity in dry eyes. Cornea 17:376–379
Paulsson LE, Sjöstrand J (1980) Contrast sensitivity in the presence of a glare light. Theoretical concepts and preliminary clinical studies. Invest Ophthalmol Vis Sci 19:401–406
Gilbard JP, Rossi SR, Azar DT, Heyda KG (1989) Effect of punctal occlusion by Freeman silicone plug insertion on tear osmolarity in dry eye disorders. CLAO J 15(3):216–218
Acknowledgments
Supported in seed fund (No. 79495-01) and Linhu fund (No. 79495-02) of Peking University Third Hospital.
Conflict of interest
There is no financial conflict of the authors in this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Qiu, W., Liu, Z., Ao, M. et al. Punctal plugs versus artificial tears for treating primary Sjögren’s syndrome with keratoconjunctivitis SICCA: a comparative observation of their effects on visual function. Rheumatol Int 33, 2543–2548 (2013). https://doi.org/10.1007/s00296-013-2769-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-013-2769-1