The effect of topical steroids and non-steroidal anti inflammatory drugs on epiphora of unknown cause: Optical coherence tomography study.

Abstract

The aim of this study is to evaluate using topical non-steroidal antiinflammatory and low-potency steroid drugs for the treatment of epiphora without an underlying cause using anterior segment-optical coherence tomography (AS-OCT) and Munk epiphora grading system. Thirty patients with epiphora who had no underlying cause were evaluated prospectively.A detailed ophthalmological examination, tear meniscus height on slit-lamp, fluorescein tear break-up time, schirmer test, lisamin green conjonctival staining, lacrimal syringing of the upper and lower canaliculus were done in all patients. The patients with contact lens wear,punctal stenosis, lacrimal system disorders, dry eye disease, eyelid malpositions, pterygium, conjunctivochalasis, conjunctivitis, blepharitis, ocular infection, and corneal disease, used topical anti-glaucomatous drugs were excluded. All patients were treated with a combination of topical low-potency drug (loteprednol etabonate 0.5%) twice daily for ten days and topical non-steroidal anti-inflammatory drug (nepafenac 0.3%)once a day for 1 month. Before and after the medical treatment protocol, tear meniscus area (TMA) and tear meniscus height (TMH) were measured by AS-OCT and patients were asked to subjectively rate their epiphora according to the Munk epiphora grading system. The effectiveness of treatment were evaluated by AS-OCT measurements and the Munk epiphora grading system. Fourteen males and sixteen females were included. The mean age at presentation was 60.1±7.35 years and duration of symptoms was 10.03±5.08 months. The mean duration of follow-up was 8.7±3.2 months. Munk epiphora grading system was significantly decreased from 2.5 to 1.6 after treatment (p: 0.004). TMH and TMA were significantly decreased on AS-OCT (TMH:402vs 309µm, p:0.001, TMA:0.797vs 0.347 mm2, p=0.006).Six of thirty patients subjectively reported that their symptoms had not improved but TMH and TMA were significantly decreased on AS-OCT. The combined use of topical non-steroidal anti-inflammatory and low-potency steroid drops may be a good option in patients with epiphora who does not have an underlying cause.