[Relative effectiveness of methods of obturating the lacrimal duct in the treatment of patients with dry eye syndrome].

Abstract

Obturation of the lacrimal duct is a new method being developed in parallel to drug therapy for the treatment of patients with dry eye syndrome (DES). However, the abundance of methods of obturation and the lack of experience with them indicates the necessity of their comparative evaluation and development of a therapeutic algorithm. To compare the effectiveness of various ways of obturating the lacrimal duct, to determine their choice and the sequence of their application in the treatment of patients with DES. The study included 85 patients with DES: 23 - on the basis of disturbed tear production, with denervation and after extirpation of the lacrimal gland; 62 - due to the combination of disturbed tear production and increased tear film evaporation: with Sjogren syndrome, Graft-versus-host reaction, and scarring pemphigoid. All patients were examined using methods of functional evaluation of the ocular surface. The effect of artificial tear after 1 month of instillations was sufficient in 31 patients. The remaining 54 patients underwent lacrimal duct obturation: at first - temporary (with catgut thread), and after it proved effective (48 patients) - permanent: Punctal plugs® (FCI), conjunctiva coating, diathermocoagulation, and canals ligation (when previous methods were ineffective). The intervention was accompanied by a decrease in the severity of DES symptoms, increased stability of the tear film and high tear meniscus index values. However, none of the methods used was absolutely reliable: recanalization of the tear ducts was noted in 28.2% after their closure by Punctal plugs, in 25-60% after conjunctival coverage, and in 51.7% after diathermocoagulation. The least traumatic way of lacrimal duct obturation is the Punctal plugs. The most reliable, but also the most traumatic is canals ligation, which was effective in re-obturation. Covering lacrimal papillae with conjunctiva occupies an intermediate position in terms of traumatism and effectiveness. During the surgery, it is reasonable to consider blocking both canals, and not just obturating the lower one.