title: Corneal sensitivity, ocular surface health and tear film stability after punctal plug therapy of aqueous deficient dry eye.
abstract: OBJECTIVE
  To evaluate the effect of punctal occlusion using thermosensitive (smart plug) versus silicone plug for management of aqueous deficient dry eye on corneal sensitivity, ocular surface health and tear film stability.
  
  
  METHODS
  A comparative prospective interventional case study included 45 patients with bilateral severe form of aqueous deficient dry eye. In each patient, the smart plug was inserted in the lower punctum of the right eye which was considered as study group 1 and silicone plug was inserted in the lower punctum of the left eye of the same patient which was considered as study group 2. All patients were subjected to careful history taking and questionnaire for subjective assessment of severity of symptoms. Corneal sensitivity, corneal fluorescein, rose bengal staining, Schirmer's I test, tear film break up time and conjunctival impression cytology were performed pre and 1, 3 and 6mo post plug insertion.
  
  
  RESULTS
  A statistically significant improvement in subjective and objective manifestations occurred following treatment with both types of plugs (P<0.01). The thermosensitive plug caused significant overall improvement, decrease in frequency of application of tear substitutes and improvement of conjunctival impression cytology parameters in the inserted side (P<0.01). Canaliculitis was reported in two eyes (4.4%) following punctal occlusion using thermosensitive plug (study group 1). Spontaneous plug loss occurred in 21 eyes (46.6%) in the silicone plug group (study group 2).
  
  
  CONCLUSIONS
  Improvement of subjective and objective manifestations of aqueous deficient dry eye occurs following punctal plug occlusion. Thermosensitive plug has good patient's compliance with fewer complications and lower rates of loss compared to the silicone plug.
authors.affiliation: Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt.
authors.forename: Azza Mohamed Ahmed
authors.initials: AM
authors.lastname: Said
authors.affiliation: Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt.
authors.forename: Mona Elsayed
authors.initials: ME
authors.lastname: Farag
authors.affiliation: Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt.
authors.forename: Tarek Mohamed
authors.initials: TM
authors.lastname: Abdulla
authors.affiliation: Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt.
authors.forename: Othman Ali Othman
authors.initials: OA
authors.lastname: Ziko
authors.affiliation: Pathology Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt.
authors.forename: Wesam Mohamed
authors.initials: WM
authors.lastname: Osman
keywords: Schirmer's test; conjunctival impression cytology; corneal fluorescein staining; corneal sensitivity; dry eye syndrome; silicone plug; thermosensitive smart plug