title: Paradoxical increase of visual impairment with punctal occlusion in a patient with mild dry eye.
abstract: We report a paradoxical increase in visual impairment after punctal plug placement despite improvement in corneal epithelial damage caused by mild dry eye. Ocular higher-order aberrations (HOAs) were measured sequentially with a wavefront sensor before and after punctal plug insertion in a patient with mild dry eye. Although postblink HOAs tend to increase in normal subjects or patients with dry eye, after treatment there was a maximum spike in HOAs for a few seconds that decreased gradually. Excessive retention of tear film by punctal occlusion may cause inferosuperior asymmetrical distribution in precorneal tear-film thickness, possibly leading to slower wavefront on the inferior cornea and increased coma-like aberrations. Increased visual impairment might occur paradoxically despite improvement in the corneal epithelial damage caused by dry eye.
authors.affiliation: Department of Ophthalmology, Osaka University Medical School, Suita, Japan.
authors.forename: Shizuka
authors.initials: S
authors.lastname: Koh
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Maeda
authors.forename: Sayuri
authors.initials: S
authors.lastname: Ninomiya
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Watanabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujikado
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Tano
authors.forename: Yoko
authors.initials: Y
authors.lastname: Hirohara
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Mihashi
mesh_terms: D000328:Adult; D001767:Blinking; D015352:Dry Eye Syndromes / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D007765:Lacrimal Apparatus / Q000601:surgery*; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012826:Silicone Elastomers; D014786:Vision Disorders / Q000209:etiology*
chemical_list: D012826:Silicone Elastomers