Paradoxical increase of visual impairment with punctal occlusion in a patient with mild dry eye.
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.
Koh
Shizuka
S
Department of Ophthalmology, Osaka University Medical School, Suita, Japan.
Maeda
Naoyuki
N
Ninomiya
Sayuri
S
Watanabe
Hitoshi
H
Fujikado
Takashi
T
Tano
Yasuo
Y
Hirohara
Yoko
Y
Mihashi
Toshifumi
T
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*
D012826:Silicone Elastomers