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    How punctal plugs may influence tear osmolarity and aid in dry eye therapies

    By retaining tears on ocular surface, punctual plugs may alleviate dry eye disease

    Take-home message: Tear osmolarity decreases with punctal plug insertion and serves as a leading indicator of therapeutic efficacy in dry eye disease.

    St. Louis—Aside from serving as an artificial barrier to loss of tears, punctal plugs may also have an effect on tear osmolarity, said Jay S. Pepose, MD, PhD.

    A recent study indicated tear osmolarity scores dropped by more than 10 mOsm/L in almost 50% of the patients tested, said Dr. Pepose, professor of clinical ophthalmology and visual sciences, Washington University School of Medicine, St. Louis.

    In a prospective clinical trial of patients with dry eye conducted at a few sites, Dr. Pepose and colleagues sought to determine first, how punctal occlusion affected tear osmolarity and second, the effect of the occlusion on the severity and frequency of symptoms, tear break-up time (TBUT), corneal staining, and meibomian gland dysfunction (MGD).

    Twenty-eight subjects were included in the study. All had been diagnosed previously with dry eye and tear film hyperosmolarity (>308 mOsm/L).

    In addition to a clinical evaluation that included measurement of the tear osmolarity, symptoms, and a slit-lamp evaluation to determine the TBUT, cornea/conjunctiva staining grade, and MGD, the patients also were asked to complete the Visual Analogue Scale questionnaire. This determined the frequency and severity of symptoms on a scale of 0 indicating no symptoms and 10 indicating high symptoms.

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