Changes of Dry Eye Parameters Especially Meibomian Gland Functions After Punctal Plugs Insertion in Aqueous-Deficient Dry Eye Patients.

Tingting Liu,Yuqin He,Mei Xu,Shulin Liu,Hongxue Fu,Meiqi Gan

doi:10.3389/fmed.2022.849700

Abstract

BackgroundThe study aimed at investigating the changes of dry eye parameters, especially the meibomian gland function in dry eye patients with primary Sjögren's syndrome (SS) and non-Sjögren's syndrome (non-SS) before and after punctal plugs insertion.Material and MethodsThe SS and non-SS dry eye patients that received punctal plugs insertion were prospectively investigated. This study recruited fifty patients. The standardized patient evaluation of eye dryness (SPEED), ocular surface disease index (OSDI), tear meniscus height (TMH), non-invasive Keratographic breakup time (NIKBUT), Schirmer test without anesthesia (Schirmer I Test, SI T), corneal fluorescein staining (CFS), the meibomian gland dropout (meiboscore), meibum expressibility score (MES), meibum quality score (MQS), lid margin abnormalities and the lipid layer thickness (LLT) were analyzed at pre-obstruction, 2 weeks, 2 months and 6 months following the obstruction.ResultsOur study observed a statistically significant improvement in ocular symptom scores (SPEED and OSDI scores) after punctal plugs insertion at every visit in both SS and non-SS patients (all p < 0.05). A similar pattern was observed in TMH, SI T, NIKBUT and CFS score in both groups (all p < 0.05), except that NIKBUT and CFS score had no obvious change in SS group at 6 months (P > 0.05). In terms of the meibomian gland evaluation, meiboscore did not change significantly, MES decreased at 2 and 6 months and MQS decreased only at 2 months in both groups. The lid margin abnormalities of the non-SS group were significantly improved at 2 and 6 months, while that of the SS group had changes only at 2 months. Interestingly, LLT in non-SS group continued to rise, reaching a higher level at 2 months (p < 0.05), while LLT in SS group increased only at 2 months (p < 0.05). Meanwhile, after the puntcal plugs insertion, non-SS group showed better outcomes concerning some parameters, such as lower ocular symptom scores, higher TMH and significantly greater LLT, compared with that in SS group (all p < 0.05).ConclusionsOur study revealed that dry eye symptoms and signs, including meibomian gland function, improved for at least 6 months in non-SS dry eye patients as well as in SS dry eye patients after punctal plugs insertion.

Highlights

The study aimed at investigating the changes of dry eye parameters, especially the meibomian gland function in dry eye patients with primary Sjögren’s syndrome (SS) and non-Sjögren’s syndrome before and after punctal plugs insertion
We found that both SS and non-SS patients had aqueous-deficient dry eye (ADDE), and showed meibomian gland dysfunction (MGD) at baseline prior punctal plugs insertion and after punctal obstruction the dry eye parameters were improved in both groups including ocular surface examination, meibum expressibility score (MES), meibum quality score (MQS), lid margin abnormalities and lipid layer thickness (LLT), but meiboscores did not change significantly
We found the symptoms and some dry eye parameters improved after punctal obstruction in SS patients, they generally did not respond to the treatment as well as non-SS patients during follow-up

Summary

Introduction

The study aimed at investigating the changes of dry eye parameters, especially the meibomian gland function in dry eye patients with primary Sjögren’s syndrome (SS) and non-Sjögren’s syndrome (non-SS) before and after punctal plugs insertion. The TFOS DEWS II report confirmed tear hyperosmolarity, along with tear instability, as the core drivers of dry eye diseases (DED) [1, 2]. Two major subtypes of DED are defined, aqueous-deficient dry eye (ADDE) and evaporative dry eye (EDE) [1]. Sjögren’s syndrome (SS) is a chronic autoimmune disease exhibiting the feature of infiltration of salivary and lacrimal glands by activated T-cells which cause acinar and ductular cell death and hyposecretion of the tears or saliva [2, 3]. As for the EDE, meibomian gland dysfunction (MGD) is considered as the main cause [1]. The background of the two kinds of DED is different from the view of pathophysiological aspect of dry eye

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