Control inflammation before using punctal occlusion to treat dry eye

SAN FRANCISCO — Dry eye syndrome may be called "dysfunctional tear syndrome" because it results from a cascade of varied but treatable pathologies, a clinician said here.

Jose A.P. Gomes, MD, discussed dysfunctional tear syndrome (DTS) and various treatment strategies during Cornea Day preceding the American Society of Cataract and Refractive Surgery meeting.

"We know that dysfunctional tear syndrome is not only a problem of quantity but it also involves the quality of the tear," Dr. Gomes said. "The tear of dry eye patients is abnormal and has decreased variety and a decreased amount of cytokines, and proteases."

DTS commonly affects the tear film, nasal-lacrimal duct, lacrimal gland and lacrimal puncta. Treatment options include tear replacement, tear production, tear preservation and anti-inflammatory agents. Punctal/canalicular occlusion with punctal plugs, thermal treatment and surgery are effective methods of treating DTS, Dr. Gomes said.

New dissolving punctal plugs have improved punctal occlusion. However, inflammation should be controlled before the occlusion is attempted, Dr. Gomes said.

In Americans aged 50 years and older (30 to 60 million), 15% to 20% of have DTS, including 9 million with moderate to severe dry eye. Only 5% if cases are correctly diagnosed and treated, Dr. Gomes said.