Aqueous deficiency dry eye in post conjunctivitis cicatrization - Effect of deep thermal punctal cautery

Abstract

Purpose: To evaluate the effect of deep thermal punctal cautery in eyes with post-conjunctivitis cicatrization.

Methods: This retrospective study consisted of patients who underwent deep thermal punctal cautery for post-conjunctivitis dry eye (PCDE). The diagnosis was based on a history suggestive of viral conjunctivitis in past followed by the onset of present clinical features of aqueous deficiency dry eye (ATD). All patients underwent a rheumatological evaluation to rule out underlying systemic collagen vascular disease as a cause for dry eye. The extent of cicatricial changes was noted. Best-corrected visual acuity (BCVA), Schirmer's test, and fluorescein staining score (FSS; total score of 9) were analyzed pre- and post-cautery.

Results: Out of 65 patients (117 eyes), 42 were males. The mean age at presentation was 25.769 ± 12.03 years. Thirteen patients presented with unilateral dry eye. Pre-cautery BCVA (logarithm of the minimum angle of resolution [logMAR]) and Schirmer's test (mm) improved from 0.5251 ± 0.662 to 0.372 ± 0.595 (P value = 0.000, 95% confidence interval [CI]: 0.09-0.22), and 1.952 ± 2.763 to 4.929 ± 4.338 (P value = 0.000, 95% CI: -3.79--2.17); post-cautery, respectively. The pre-cautery FSS of 5.9 ± 2.82 reduced to 1.58 ± 2.38 (P value = 0.000, 95% CI: 3.46-5.17) post-cautery. The mean follow-up was 11.22 ± 13.32 months. No progression in cicatricial changes was noted in any eye during the follow-up. Re-canalization rate was 10.64%, and repeat cautery was performed with successful closure of puncta.

Conclusion: Symptoms and clinical signs of ATD in PCDE patients improve with punctal cautery.

Keywords: Conjunctival cicatricial disease; dry eye; post-conjunctivitis dry eye; punctal cautery.

Figure 1

Slit-lamp photographs of case illustration showing marked improvement in clinical signs post-cautery: a) sub tarsal scarring right upper lid, b) corneal nummular opacities post adenoviral keratitis, c and d) severe corneal staining in OD and OS resp. before cautery, e and f) at 1-month post-cautery, no corneal staining was noted in OD and OS resp., g, h, and i) fluorescein staining in OD pre cautery, showing the superior, medial, and lateral conjunctival staining, j, k and l) no conjunctival staining noted at 1-month post cautery

Figure 2

Images of non-invasive tear break-up time (NITBUT) obtained using keratograph for case illustration revealed a marked improvement in the first and average breakup time (BUT): a) average BUT of 5.86 s in OD pre punctal cautery, b) average BUT of 15.81 s post-procedure in the same eye, c) OS average BUT of 7.29 s pre-cautery, d) average BUT of 14.35 s post-procedure in the same eye. The first BUT continued to remain short in the left eye, attributable to the nummular scar

Figure 3

Slit-lamp images of patient of PCDE OU for 2 years (h/o conjunctivitis, all family members affected): a and b) OD conjunctival congestion and photophobia, c) supero-temporal band of symblepharon, d) sub-tarsal scarring, e and f) abnormal tear film (reduced FBUT-2 s and TMH), g, h, and i) 2-month post cautery, ease in opening eye, decreased conjunctival congestion, j, k, l, and m) OS medial symblepharon, congested conjunctiva and sub-tarsal scarring, n and o) irregular fluorescein stain and corneal scar, p, q, and r) moist OS and FBUT-8 s

Figure 4

Images of NITBUT by keratograph of the same patient showing an improvement in the first and average BUT: a) average break-up time of 6.8 s in right eye pre punctal cautery, b) average break-up time of 20.12 s post-procedure in the same eye, c) left eye average break-up time of 8.97 s pre-cautery, d) improving to 15.26 s post-procedure in the same eye. The first BUT continued to remain short in the left eye, attributable to the corneal scar