Dry eye syndrome is a common ocular condition, affects 6 - 34 % of the global adult population. It significantly reduces vision related quality of life (1). It is subdivided into two forms, aqueous-deficient (tear deficiency) and hyper evaporative (increased evaporation). However, mixed forms are common (2). It is an inflammatory disease that has many features in common with autoimmune disease. Stress to the ocular surface (environmental factors, infection, endogenous stress, antigens, genetic factors) is postulated as the pathogenetic triggering mechanism (3, 4). The primary determinant for the therapeutic strategy of dry eye is the severity of the disease. Additionally, a stepwise guide to approach the best combination of medications to
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The method in common use is to plug the punctum with silicone plugs of various sizes and designs (7). Punctum plug occlusion in aqueous-deficient dry eye is shown to provide improvement of subjective symptom scoring (8), tear-film stability, ocular surface staining scores, and tear osmolarity (9). Recognized complications of conventional silicone plugs include epiphora, punctal ring rupture, abrasion of the corneal and conjunctival surface, and suppurative canaliculitis (10). Extrusion of silicone plugs is common, occurring within 3 months in up to 50% of cases (11). The intracanalicular Smart Plug (Medennium, Inc. Irvine, California) made from a thermosensitive hydrophobic acrylic polymer has been in clinical use since 2002. The Smart Plug is solid at room temperature but becomes a soft gel at body temperature, thus fixating it in the canaliculus. Noncomparative studies have suggested some clinical improvement by using the Smart-Plug (12, 13). The aim of this study was to evaluate the efficacy and safety of the acrylic thermosensitive punctual plug (Smart Plug) compared to the silicone plug in management of patients with severe aqueous deficient type of dry eye syndrome, those patients were on maximally tolerable topical lubricant therapy for more than six months prior to plug
The method in common use is to plug the punctum with silicone plugs of various sizes and designs (7). Punctum plug occlusion in aqueous-deficient dry eye is shown to provide improvement of subjective symptom scoring (8), tear-film stability, ocular surface staining scores, and tear osmolarity (9). Recognized complications of conventional silicone plugs include epiphora, punctal ring rupture, abrasion of the corneal and conjunctival surface, and suppurative canaliculitis (10). Extrusion of silicone plugs is common, occurring within 3 months in up to 50% of cases (11). The intracanalicular Smart Plug (Medennium, Inc. Irvine, California) made from a thermosensitive hydrophobic acrylic polymer has been in clinical use since 2002. The Smart Plug is solid at room temperature but becomes a soft gel at body temperature, thus fixating it in the canaliculus. Noncomparative studies have suggested some clinical improvement by using the Smart-Plug (12, 13). The aim of this study was to evaluate the efficacy and safety of the acrylic thermosensitive punctual plug (Smart Plug) compared to the silicone plug in management of patients with severe aqueous deficient type of dry eye syndrome, those patients were on maximally tolerable topical lubricant therapy for more than six months prior to plug