{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:35:09Z","timestamp":1791264909128,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T00:00:00Z","timestamp":1702944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japanese Ministry of Education, Culture, Sports, Science and Technology","award":["16K11269"],"award-info":[{"award-number":["16K11269"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Punctal occlusion (PO) is considered to improve both tear-film instability and increased friction during blinking and may consequently affect blinks. The purpose of this study was to investigate the effect of PO on blinks. This study involved 16 eyes of 16 severe aqueous deficient dry eye (ADDE) patients (mean age: 65.7 years). In all eyes, tear meniscus radius (TMR), spread grade (SG) of the tear-film lipid layer (i.e., SG 1-5: 1 being the best), fluorescein break-up time (FBUT), corneal epithelial damage score (CED), conjunctival epithelial damage score, corneal filament (CF) grade, lid-wiper epitheliopathy (LWE) grade, and superior limbic keratoconjunctivitis (SLK) grade were evaluated at before and at more than 1-month after PO. Moreover, using a custom-made high-speed blink analyzer, palpebral aperture height, blink rate, upper-eyelid closing-phase amplitude\/duration\/maximum velocity, and upper-eyelid opening-phase amplitude\/duration\/maximum velocity were measured at the same time point. After PO, TMR, SG, FBUT, CED, and the CF, LWE, and SLK grades were significantly improved, and upper-eyelid opening\/closing-phase amplitude and maximum velocity significantly increased (all p &lt; 0.04). The findings of this study suggest that PO improves ocular surface lubrication and that blink-related parameters can reflect the friction that occurs during blinking in eyes with severe ADDE.<\/jats:p>","DOI":"10.3390\/diagnostics14010003","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T04:18:37Z","timestamp":1702959517000},"page":"3","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effect of Punctal Occlusion on Blinks in Eyes with Severe Aqueous Deficient Dry Eye"],"prefix":"10.3390","volume":"14","author":[{"given":"Hiroaki","family":"Kato","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4839-3416","authenticated-orcid":false,"given":"Norihiko","family":"Yokoi","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihide","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aoi","family":"Komuro","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiko","family":"Sonomura","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chie","family":"Sotozono","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeru","family":"Kinoshita","sequence":"additional","affiliation":[{"name":"Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jtos.2016.09.003","article-title":"New perspectives on dry eye definition and diagnosis: A consensus report by the Asia Dry Eye Society","volume":"15","author":"Tsubota","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jtos.2017.05.003","article-title":"TFOS DEWS II Epidemiology Report","volume":"15","author":"Stapleton","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2378","DOI":"10.4103\/ijo.IJO_2306_20","article-title":"Impact of the COVID-19 lockdown on digital devicerelated ocular health","volume":"68","author":"Bahkir","year":"2020","journal-title":"Indian J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jtos.2017.05.008","article-title":"TFOS DEWS II definition and classification report","volume":"15","author":"Craig","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"DES13","DOI":"10.1167\/iovs.17-23700","article-title":"Tear film-oriented diagnosis and tear film-oriented therapy for dry eye based on tear film dynamics","volume":"59","author":"Yokoi","year":"2018","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_6","first-page":"309","article-title":"Definition and diagnosis of dry eye in Japan, 2016","volume":"34","author":"Shimazaki","year":"2017","journal-title":"Atarashii Ganka (J. Eye)"},{"key":"ref_7","first-page":"OP874-9","article-title":"The punctum plug: Evaluation of a new treatment for the dry eye","volume":"70","author":"Freeman","year":"1975","journal-title":"Trans. Am. Acad. Ophthalmol. Otolaryngol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/00003226-200203000-00001","article-title":"The clinical efficacy of silicone punctal plug therapy","volume":"21","author":"Tai","year":"2002","journal-title":"Cornea"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.jtos.2017.05.006","article-title":"TFOS DEWS II management and therapy report","volume":"15","author":"Jones","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_10","first-page":"CD006775","article-title":"Punctal occlusion for dry eye syndrome","volume":"6","author":"Ervin","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.exer.2003.09.020","article-title":"Non-invasive methods of assessing the tear film","volume":"78","author":"Yokoi","year":"2004","journal-title":"Exp. Eye Res."},{"key":"ref_12","first-page":"413","article-title":"Filamentary keratitis","volume":"33","author":"Beetham","year":"1935","journal-title":"Trans. Am. Ophthalmol. Soc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.ajo.2020.05.037","article-title":"Clinical manifestation and risk factors associated with remission in patients with filamentary keratitis","volume":"218","author":"Lee","year":"2020","journal-title":"Am. J. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.survophthal.2021.04.002","article-title":"A review of filamentary keratitis","volume":"67","author":"Weiss","year":"2022","journal-title":"Surv. Ophthalmol."},{"key":"ref_15","first-page":"211","article-title":"Lid-wiper epitheliopathy and dry-eye symptoms in contact lens wearers","volume":"28","author":"Korb","year":"2002","journal-title":"CLAO J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/01.ICL.0000140910.03095.FA","article-title":"Lid wiper epitheliopathy and dry eye symptoms","volume":"31","author":"Korb","year":"2005","journal-title":"Eye Contact Lens"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1097\/ICO.0b013e31823f8d8c","article-title":"The lid wiper contains goblet cell crypts for ocular surface lubrication during the blink","volume":"31","author":"Knop","year":"2012","journal-title":"Cornea"},{"key":"ref_18","first-page":"25","article-title":"Superior limbic keratoconjunctivitis","volume":"42","author":"Theodore","year":"1963","journal-title":"Eye Ear Nose Throat Mon."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1001\/archopht.1970.00990040483016","article-title":"Superior limbic keratoconjunctivitis. Clinical and pathological correlations","volume":"84","author":"Theodore","year":"1970","journal-title":"Arch. Ophthalmol."},{"key":"ref_20","first-page":"1","article-title":"High-speed measurement system of blinks by using Intelligent Vision Sensor","volume":"Volume 109","author":"Suzuki","year":"2009","journal-title":"The Institute of Electronics, Information and Communication Engineers Technical Report"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1097\/ICO.0000000000001841","article-title":"Relationship between ocular surface epithelial damage, tear abnormalities, and blink in patients with dry eye","volume":"38","author":"Kato","year":"2019","journal-title":"Cornea"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.ajo.2017.05.022","article-title":"Classification of fluorescein breakup patterns: A novel method of differential diagnosis for dry eye","volume":"180","author":"Yokoi","year":"2017","journal-title":"Am. J. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/S0161-6420(95)31024-X","article-title":"Dry eye with only decreased tear break-up time is sometimes associated with allergic conjunctivitis","volume":"102","author":"Toda","year":"1995","journal-title":"Ophthalmology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1001\/archopht.121.2.173","article-title":"Differentiation of lipid tear deficiency dry eye by kinetic analysis of tear interference images","volume":"121","author":"Goto","year":"2003","journal-title":"Arch. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/S0002-9394(03)00317-9","article-title":"Diagnosing dry eye using a blue-free barrier filter","volume":"136","author":"Koh","year":"2003","journal-title":"Am. J. Ophthalmol."},{"key":"ref_26","first-page":"221","article-title":"Report of National Eye Institute\/Industry workshop on Clinical Trials in Dry Eyes","volume":"21","author":"Lemp","year":"1995","journal-title":"CLAO J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1001\/archopht.1969.00990020012003","article-title":"Diagnostic tests in sicca syndrome","volume":"82","year":"1969","journal-title":"Arch. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"171","DOI":"10.3109\/02713683.2015.1009636","article-title":"Involvement of eyelid pressure in lid-wiper epitheliopathy","volume":"41","author":"Yamamoto","year":"2016","journal-title":"Curr. Eye Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"DES56","DOI":"10.1167\/iovs.17-23586","article-title":"Relationship between eyelid pressure and ocular surface disorder in patients with healthy and dry eyes","volume":"59","author":"Yamaguchi","year":"2018","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_30","first-page":"65","article-title":"The preocular tear film; a small but highly complex part of the eye","volume":"80","author":"Holly","year":"2005","journal-title":"Arch. Soc. Esp. Oftalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"653","DOI":"10.3109\/02713689609008906","article-title":"Tear meniscus measurement in the diagnosis of dry eye","volume":"15","author":"Mainstone","year":"1996","journal-title":"Curr. Eye Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1111\/j.1755-3768.1967.tb06537.x","article-title":"A new division of the conjunctiva on the basis of x-ray examination","volume":"45","author":"Kessing","year":"1967","journal-title":"Acta Ophthalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1046\/j.1442-9071.2003.00633.x","article-title":"Blink-related microtrauma: When the ocular surface harms itself","volume":"31","author":"Cher","year":"2003","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/S1542-0124(12)70271-9","article-title":"A new look at lubrication of the ocular surface: Fluid mechanics behind the blinking eyelids","volume":"6","author":"Cher","year":"2008","journal-title":"Ocul. Surf."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/j.1442-9071.2012.02758.x","article-title":"Fluids of the ocular surface: Concepts, functions and physics","volume":"40","author":"Cher","year":"2012","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.jtos.2014.12.004","article-title":"Spontaneous blinking from a tribological viewpoint","volume":"13","author":"Pult","year":"2015","journal-title":"Ocul. Surf."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"973","DOI":"10.2147\/OPTH.S360293","article-title":"Tribology and the ocular surface","volume":"30","author":"Lievens","year":"2022","journal-title":"Clin. Ophthalmol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"23037","DOI":"10.1074\/jbc.M109.033332","article-title":"Association of cell surface mucins with galectin-3 contributes to the ocular surface epithelial barrier","volume":"284","author":"Mantelli","year":"2009","journal-title":"J. Biol. Chem."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"114074","DOI":"10.1016\/j.addr.2021.114074","article-title":"Human ocular mucins: The endowed guardians of sight","volume":"180","year":"2022","journal-title":"Adv. Drug Deliv. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.aanat.2007.05.001","article-title":"Regulation of MUC16 by inflammatory mediators in ocular surface epithelial cell lines","volume":"190","author":"Paulsen","year":"2008","journal-title":"Ann. Anat."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1167\/iovs.07-1081","article-title":"Release of membrane-associated mucins from ocular surface epithelia","volume":"49","author":"Blalock","year":"2008","journal-title":"Investig. Ophthalmol. Vis. Sci."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/1\/3\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:41:16Z","timestamp":1760132476000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/1\/3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,19]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["diagnostics14010003"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14010003","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,19]]}}}