Argon laser punctal therapy versus thermal cautery for the treatment of aqueous deficiency dry eye syndrome.

BACKGROUND: The objective of this prospective randomized study was to compare the safety and efficacy of argon laser punctal ablation and electrocautery punctal occlusion in the treatment of moderate to severe dry eye and to correlate standard clinical signs with symptoms in these patients.

METHODS: From June 1996 to April 1997 we studied 32 patients (64 eyes) referred to a university-affiliated tertiary care hospital with signs or symptoms of dry eye. Moderate to severe dry eye was confirmed by means of the Schirmer 1 test, fluorescein and rose bengal staining and a visual analogue scale measure of six subjective symptoms. Patients with severe dry eye were randomly assigned to undergo argon laser ablation (17 eyes) or electrocautery occlusion (18 eyes), and were reassessed 2 weeks, 1 month and 6 months after treatment.

RESULTS: Compared with baseline, the laser-treated patients had a peak improvement of 40% in surface wetting at 1 month and improvement of 33% at 6 months; the peak improvement at 6 months in the electrocautery group was 84% (p < 0.05). At 6 months the laser group had a twofold reduction in rose bengal staining, compared with a sevenfold reduction in the electrocautery group (p < 0.05). The electrocautery group had the greatest decrease in fluorescein staining at 6 months (2.8-fold vs. twofold) (p < 0.05). The laser group reported a reduction in symptoms of 31% at 1 month and 14% at 6 months; the corresponding values for the electrocautery group were 55% and 64% (p = 0.02). Posttreatment epiphora was insignificant in both groups. In patients with surface wetting of more than 5 mm at baseline, regular use of Tear-Gel resulted in both objective and subjective improvement.

INTERPRETATION: Although argon laser punctal ablation is a safe method of treating aqueous tear deficiency states, with minimal side effects, both subjective and objective improvement were greater with electrocautery punctal occlusion. Intensive use of Tear-Gel offers benefit to patients with debilitating symptoms in whom aqueous tear production is not severely reduced.