Dry Eye Help-Punctal Occlusion
One way to alleviate dry eye is to help the eyes to make better and longer use of the small amount of lubricating tears they do produce. This is accomplished by closing off the small funnel-like drain hole found in the inner corner of the upper and lower eyelids. These drain holes, called punctums can be closed with tiny plugs called punctal plugs. The plugs can be placed in the two tear ducts, top and bottom, in both eyes or in only the lower ducts.
Punctal plugs can be temporary or permanent. Temporary plugs dissolve a few days after insertion. If your dry eye symptoms disappear when the temporary plugs are inserted, your doctor may consider permanent punctal occlusion.
Punctal occlusion is for those:
who have been diagnosed with dry eye
whose doctor has determined that punctal occlusion is the appropriate treatment for their condition
What to expect on procedure day:
Your treatment will be performed in an examination room. It does not require a surgery center. Once you have been checked in and settled comfortably, drops will be used to numb your eye; no injections or needles are used.
Your doctor will pull your eyelid up and ask you to look toward the outside of your head, away from your nose. Using a forceps-like applicator, the plug will be placed into the corner of your eye, then released. An applicator or another tool will then be used to gently push the plug into your natural punctal opening and you'll be asked to blink. Once the plugs get wet, they will expand to completely fill the opening. The entire procedure takes only a few minutes. Many patients report immediate relief from dry eye symptoms and resume normal activities immediately.
Realistic expectations:
Serious complications with punctal occlusion are extremely rare, but like any medical procedure, it does have some risks. If you experience side effects, your doctor can remove the plugs. Going to a specialist experienced in punctal occlusion can significantly minimize risks.
If you and your doctor decide that punctal occlusion is an option for you, you will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed.
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Care with your face soap!
A new study reveals that a person’s choice of soap may play a role in eye infections.
This article appeared in EyeWorld, an international newsmagazine for ophthalmologists
by Lisa Samalonis, Correspondent
Using antibacterial/deodorant soap before surgery can reduce the amount of external disease in ocular surgery compared with using nonbacterial soap.
In addition, patients with recurring eye infections who use deodorant/antibacterial soap daily or at least several times a week can decrease disease significantly.
A recent study he conducted included 427 consecutive patients with significant eye infection com-plaints. Diagnoses included ble- pharitis, meibomianitis, chalazia, and corneal ulcer. Criteria for the study required that patient treatments included topical antibiotic drops, topical antibiotic ointment, oral antibiotics, and hot compresses.
The patients were given a ques- tionnaire on symptoms and perso- nal hygiene. Of the 427 cases, 89% of patients indicated they used nondeodorant soaps. Of the 89% that used nonantibacterial/non- deodorant soap, 224 cases (52%) said they used Ivory. Other non- deodorants used were Dove (72 cases, 17%), Neutrogena (34 cases, 8%), tap water (30 cases, 7%), cold cream (34 cases, 8%), Canay (15 cases, 4%) and others (23 cases, 5%).
The remaining 11% of patients said they use deodorant/antibacterial soaps, such as Safeguard (13 cases, 3%), Dial (nine cases, 2.1%), Irish Spring (seven cases, 1.6%), Lever 2000 (five cases, 1.2%), Coast (five cases, 1.2%), Zest (four cases, 0.9%), or others (five cases, 1.2%). The study included double- blind cultures from 62 consecutive patients with eye infection complaint, it was fount that 16 patients used deodorant soap and 46 used nondeodorant/antibacterial soap. "Results from the double-blind culture showed that Staphylococcus epi-dennis and aureus infections occurred in 52% of the nondeodor- ant/antibacterial soap users, while 30% occurred with the deodorant- /antibacterial soap users,' he said. The study was performed with patients from the Houston area. According to the study, deodorant soap represents about two-thirds of soap sold in the area. For example, Safeguard represents about 18% of the soap sold in Houston, roughly three times Ivory sales. The Safeguard patients represented 3% of cases treated. Fifty-two percent of the cases treated were Ivory soap users. In this study, deodorant soap was used by 11% of severely infect- ed patients. There was one Safeguard case for every 16 Ivory cases. "Eighty-nine of every 100 bacterial external disease infections will use a nondeodorant facial soap.'
Recommendations
"Based on the results of this study, doctors should recommend deodor- ant/antibacterial soap to patients with contact lenses, especially extended wear contact lenses, recurrent chalazia, and Staphylococcus marginal ulcers," he said.
Most surgeons recommend that deodorant soap be used before and after intraocular and refractive surgery.
Research indicated that the soap does not have to be used every day. “I suggest to patients who are sensitive to antibacterial soaps that they use it in their morning shower or every other morning or every third morning.” “For patients with a long history of recurrent staph ulcers, using Safeguard or Irish Spring every other day seems to break the cycle.” Further study "Although preoperative use of antiseptic/deodorant soaps seems rea- sonable to reduce the rate of infection, further study is needed to prove this point.
Stark noted that multiple studies have shown that topical antibiotic agents given preoperatively, reduce the amount of lid and conjunctival bacteria. Patient's normal lid and conjunctival flora are the most potential sources of infection during intraocular surgeries. Various staphylococcal species, which are the most common organisms causing endophthalmitis, predominate in this flora. “Application of 5% povidone iodine solution on the eye at the time of surgical preparation causes a similar decrease in the number of bacterial colonies. Such prophylactic measures may help reduce the incidence of endophthalmitis, although the evidence is inconclusive,' he said. Routine use of preoperative antibiotics or antiseptic soaps may lead to alteration of protective nor- mal host flora, development of resistant bacteria, and allergic reactions, he said. “In a large study, up to 95% of eyes had positive culture results for organisms capable of causing severe intraocular infections, yet few of those eyes went on to develop infections," Stark said.
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