Inferior punctal occlusion with removable silicone punctal plugs in the treatment of dry-eye related contact lens discomfort.

Thirty subjects complaining of a decrease in soft contact lens wearing time secondary to dry eye discomfort were selected for our study. All subjects were between the ages of 25 and 40 and selected on the basis of subjective dry eye complaints alone. Five of these subjects had punctum that were too small to facilitate plug placement and were therefore eliminated from further study. Removable silicone punctal plugs were monocularly placed in the lower puncta of the remaining 25 subjects. In an attempt to minimize the placebo effect, both puncta were manipulated equally prior to plug insertion and the patient was not told which eye had been treated. Three weeks following plug placement, blind data assessment showed that 18 of the 25 subjects reported, on average, a 34.6 percent increase in comfortable contact lens wearing time in the treated eye. Three subjects reported no subjective increase in comfortable wearing time and four subjects were unable to tolerate the punctal plugs for more than a week due to plug-related discomfort. Problematic epiphora was not reported in any of the treated eyes. Reversible inferior punctal occlusion, when tolerated, can significantly increase comfortable contact lens wearing time while still allowing enough drainage from the upper puncta to prevent epiphora.