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Effect of Punctal Occlusion on Tear Menisci in Symptomatic Contact Lens Wearers

Li, Ming MD; Wang, Jianhua MD, PhD; Shen, Meixiao MSc; Cui, Lele MD; Tao, Aizhu MD; Chen, Zhao MD; Ge, Lili MD; Lu, Fan MD, OD

doi: 10.1097/ICO.0b013e31823f8d9e
Clinical Science

Purpose: To investigate by ultrahigh resolution optical coherence tomography the effect of punctal occlusion on tear menisci in symptomatic and asymptomatic contact lens wearers.

Methods: Symptomatic subjects with self-reported dry eyes (n = 20) and asymptomatic subjects (n = 20) were recruited. For each subject, 1 eye was randomly chosen for both upper and lower punctal occlusion with collagen plugs. Ultrahigh resolution optical coherence tomography imaged both upper and lower tear menisci before punctal occlusion, and 1, 4, 7, and 10 days afterward. Comfort scoring, noninvasive tear break-up time, tear break-up time, and Schirmer test with anesthesia were also performed.

Results: Tear meniscus variables in the symptomatic group were lower than those in the asymptomatic group (P < 0.05) at all time points except for day 4. In the symptomatic group, the tear menisci were increased up to day 4 after punctal occlusion (P < 0.05). The increase was present only on day 1 in the asymptomatic group. Improvement of comfort scores and noninvasive tear break-up time occurred in both groups after occlusion (P < 0.05). The comfort scores were linearly correlated with the tear volumes after punctal occlusion, with higher correlation coefficients in the symptomatic group.

Conclusions: Punctal occlusion transiently increased tear menisci in symptomatic and asymptomatic lens wearers, with a longer duration in the symptomatic group. For both symptomatic and asymptomatic lens wearers, the increased meniscus volume was associated with improved ocular comfort.

*School of Ophthalmology and Optometry

Department of Ophthalmology, Eye Hospital, Wenzhou Medical College, Wenzhou, Zhejiang, China

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL.

Reprints: Fan Lu, School of Ophthalmology and Optometry, Wenzhou Medical College, 270 Xueyuan Rd, Wenzhou, Zhejiang, China 325027 (e-mail:

Supported by research grants from the Zhejiang Provincial Program for the Cultivation of High-Level Innovative Health Talents; Zhejiang Provincial Natural Science Foundation of China (Y2090674 to M.S.); and Innovative Program of Eye Hospital, Wenzhou Medical College, China (YNZD201004 to A.T.).

The authors state that they have no proprietary interest in any of the materials or methods described in this article.

Received April 19, 2011

Accepted July 5, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.