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  • Title: Paradoxical increase of visual impairment with punctal occlusion in a patient with mild dry eye.
    Author: Koh S, Maeda N, Ninomiya S, Watanabe H, Fujikado T, Tano Y, Hirohara Y, Mihashi T.
    Journal: J Cataract Refract Surg; 2006 Apr; 32(4):689-91. PubMed ID: 16698499.
    Abstract:
    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.
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