ARTICLE | OPHTHALMOLOGY | THE CHEDLY PUNCTAL OCCLUDER: A NEW TREATMENT MODALITY FOR
Chedly Bouzouaya and Peter Raus discuss the treatment options available to treat dry eye syndrome ® a common condition treated by ophthalmologists
DRY EYES
ABSTRACT Objective Dry eye syndrome is a common disorder, generally occurring in those over 40 years of age. The management of this condition is related to the severity of the symptoms. Permanent punctal occlusion is indicated for those patients experiencing severe dry eye syndrome.
Methods With the use of a high-frequency, low-temperature surgical device and electrode specifically
designed to cauterise and close the punctum, a large number of patients were treated and relieved from the symptoms of dry eye syndrome. The Chedly Punctal Occluder (CPO) electrode is designed to both dilate the punctum and be inserted in the lumen of the lacrimal duct to seal it.
Results When there is an indication for a permanent punctal occlusion, the CPO, with the use of a high frequency device, seals the
especially those older than 40 years of age. It is estimated that nearly 75% of people over age 65 years will experience dry eye syndrome1
D
CHEDLY BOUZOUAYA, MD is Oculoplastic and Ophthalmic Surgeon, Tunisia; and PETER RAUS, MD is Ophthalmologist and Oculoplastic Surgeon, Belgium.
email:
chedly@bouzouaya.com;
Peter.raus@skynet.be
KEYWORDS dry eye syndrome, Chedly Punctal Occluder, radiofrequency, safety, cost-effective
30 ❚ . Dry eye is a multifactorial
disease of the tears and ocular surface that results in symptoms of discomfort, and tear film instability with potential damage to the ocular surface1
. Dry eye is accompanied by increased osmolarity of
the tear film and inflammation of the ocular surface, and has been classified into two main categories by the US National Eye Institute2
:
■ Aqueous tear deficiency (ATD) ■ Evaporative dry eye. Tear-deficient dry eye can be further separated into
Sj˜ grenÕs syndrome-related dry eye, an autoimmune disorder affecting the lacrimal and salivary glands, and non-Sj˜ grenÕs syndrome dry eye, which encompasses the range of other causes of tear deficiency. Evaporative dry eye is caused by deficiency and/or
alterations in lipid secretions as a result of meibomian gland dysfunction (MGD). Although differentiating patients according to the main causative factor is useful for diagnosis and therapy, clinical presentation is often a mixture of both pathogenic pathways3, 4
. Severe forms of dry eye syndrome associated with March 2012 |
prime-journal.com Figure 2 The Chedly Punctal Occluder Lacrimal sac Lacrimal canal
Nasolacrimal duct
Figure 1 Anatomy of the lacrimal drainage system in frontal view
punctum permanently. There are no cases of reopening of the punctum and no lid notch as seen with the use of electrocautery or lasers.
Conclusions Permanent punctal occlusion in severe dry eye syndrome using silicone plugs, argon laser, diode laser or cautery have drawbacks, are not cost-effective, and showed lower success rates in comparison with an easy-to- use and cost-effective punctal occluder electrode.
RY EYE SYNDROME IS ONE OF THE most common problems treated by ophthalmologists. It is estimated that over 10 million Americans suffer from dry eye syndrome (also known as keratoconjunctivitis sicca), and
Sj˜ grenÕs syndrome or skin diseases such as rosasea, can lead to vision-threatening complications, such as keratitis, corneal scarring, and vision disruption; therefore, early differential diagnosis is important. Most cases of dryness develop gradually over many years, with decreasing tear production and ocular surface damage as the final stages. Non-Sj˜ grenÕs syndrome dry eye seems to deteriorate more slowly and less profoundly than dry eye associated with primary and secondary Sj˜ grenÕs syndrome5
. Owing
to its intractable development, therapy of dry eye syndrome is often frustrating for patients and unrewarding for ophthalmologists. This makes the assessment of prognosis and patient counselling difficult. Therefore, it is paramount to find the most efficient therapeutic solutions to assist patients ® even surgical solutions such as the salivary gland transplantation6
.
Diagnosing dry eye syndrome The signs of dry eye can include conjunctival pleating, conjunctival vascular dilation, irregular corneal surface, increased debris in the tear film, and epithelial keratopathy. Rose bengal staining is an indicator of
1 mm 2 mm 1.5 mm 4 mm
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