title: [The punctum plug as an option for treating retrograde air flow from the lacrimal sac].
abstract: BACKGROUND
  The causes of keratoconjunctivitis sicca are multifarious. Major causes include eyelid anomalies, Sjögren's disease, injuries, radiation or mucin deficiency. In our case, nasal positive airway pressure due to muscular dystrophy is described as another possible cause.
  
  
  METHODS
  A 32-year-old male patient with advanced Duchenne muscular dystrophy requires nasal continuous positive airway pressure ventilation due to loss of the auxiliary respiratory muscles. The patient presented because permanent air flow from the lower right lacrimal point resulted in epiphora and keratoconjunctivitis sicca on the right side.
  
  
  METHODS
  We reversibly occluded the lower lacrimal duct with a punctum plug flow regulator. The lacrimal flow regulator is available in two sizes, 0.8 and 0.9 mm, and is designed to be inserted into the punctal aperture. The soft silicone plug is delivered with a disposable dilator and can be used on an outpatient basis. It is actually used for punctal occlusion in patients with chronic dry eye syndrome and regulates the flow of lacrimal fluid. After insertion of a 0.9 mm punctal plug, the patient reported marked improvement of the findings, which was confirmed in a follow-up after 4 and 8 weeks. On a visual analog scale of 1 to 10, the subjective status was given a rating of 8.
  
  
  CONCLUSIONS
  By occluding the right lower lacrimal point with a punctal plug, we were able to markedly reduce the unpleasant retrograde air flow and the subjective complaints of the patient with nasal continuous positive airway pressure ventilation.
authors.affiliation: Klinik und Poliklinik für Hals-Nasen- und Ohrenheilkunde, Charité--Universitätsmedizin Berlin. oender.goektas@charite.de
authors.forename: O
authors.initials: O
authors.lastname: Göktas
authors.forename: A
authors.initials: A
authors.lastname: Haberman
authors.forename: A
authors.initials: A
authors.lastname: Thelen
authors.forename: T
authors.initials: T
authors.lastname: Schrom
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D006801:Humans; D007638:Keratoconjunctivitis Sicca / Q000628:therapy*; D007766:Lacrimal Apparatus Diseases / Q000209:etiology / Q000628:therapy*; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000628:therapy*; D019919:Prosthesis Implantation; D012133:Respiratory Paralysis / Q000628:therapy*; D013525:Surgical Instruments