Punctal occlusion in the management of chronic Stevens-Johnson syndrome

Purpose: To evaluate the effect of lacrimal punctal occlusion in the management of the ocular surface disease in chronic Stevens-Johnson syndrome. Design: Retrospective noncomparative case series. Participants: Thirty-one eyes of 18 patients with chronic Stevens-Johnson syndrome seen at the Department of Ophthalmology of the Tokyo Dental College were studied. Intervention: Patients' lacrimal puncta were occluded by cauterization or with punctal plugs. Main Outcome Measures: The effect of lacrimal punctal occlusion was evaluated by changes in subjective symptoms, best-corrected visual acuity (VA), Schimer test, tear clearance test, and ocular surface double vital staining before and after punctal occlusion. Results: After lacrimal punctal occlusion, symptomatic improvement was observed in 19 eyes (61.3%). The mean logarithmic VA showed significant improvement from -0.64 +/- 0.87 to -0.52 +/- 0.86 (P<0.05). The Schirmer I test results before punctal occlusion yielded a mean score of 7.4 +/- 8.7 mm, which changed to 10.2 +/- 8.3 mm after punctal occlusion. The mean preocclusion and postocclusion tear clearance values were 7.5 +/- 6.6 times and 4.9 +/- 4.8 times, respectively. The Rose Bengal staining score decreased from 4.7 +/- 2.8 to 2.7 +/-2.2 points (P<0.05), and the fluorescein staining score decreased from 5.0 +/- 2.3 to 2.2 +/- 2.5 points (P<0.05), respectively. Conclusions: Concurrent improvements in subjective symptoms, vital staining scores, and VA point to the favorable effects of lacrimal punctal occlusion for the ocular surface health in chronic Stevens-Johnson syndrome. Ophthalmology 2004;111:895-900 (C) 2004 by the American Academy of Ophthalmology.