We thank Drs Grassi and Lim 1 for raising some important points of discussion with regards to our trial. 2 The majority of subjects in our trial were using latanoprost as their respective prostaglandin analogue (PGA). We agree that type of PGA may have led to different baseline ocular surface disease (OSD) characteristics. However, at baseline, we did not find any significant differences between subjects using latanoprost containing or using different PGAs, in both objective and subjective measures of OSD (all P > 0.05). This failure may resulted from low statistical power, as we were underpowered to perform such sub-group analyses. Further additional analyses performed showed that the plug insertion improved markers of OSD irrespective of PGA type, consistent with results from our main paper, and keeping our conclusions valid. 2 We agree that knowledge of crystalline lens status is important in a trial investigating possible changes in intraocular pressure (IOP). There was only one trial subject with a diagnosis of primary angle-closure glaucoma, who was pseudophakic during study enrolment and duration, and exhibited a documented open angle and absence of PAS at study entry. Throughout the short-study duration, no subjects received any cataract surgery, which has been shown to lower IOP even in eyes with open angles. 3 In addition, no trial participant received any type of laser therapy (peripheral iridotomy/iridoplasty, selective laser trabeculoplasty, posterior capsulotomy) during the study.Our trial was performed in a real-world clinical setting where puncta vary in size and shape and where multiple PGAs are available and in use. Several reports have now linked topical glaucoma drops with punctal stenosis and other problems with the nasolacrimal system. 4,5 It is important to be aware of such limitations with this intervention. Nonetheless, our statistical analysis was performed as intention-to-treat, and even though plug insertion was impossible or short-lived in a minority, the overall outcome of the intervention supported a beneficial effect.This small trial provides valuable information regarding the utility of punctal plugs as a mechanism to improve markers of OSD and lower IOP. These findings are encouraging, although further supportive evidence is required. We suggest considering the following issues in planning further relevant research: (a) ensuring a sufficiently large sample size to ensure adequate power for sub-group analyses; (b) using only one type of PGA; (c) enrolling a homogenous type of glaucoma (eg, primary open-angle glaucoma); and (d) controlling for lens status (eg, enrolling only pseudophakic subjects). Nonetheless, despite minor shortcomings, we hope that these findings lead to further research regarding OSD in glaucoma, a major source of reduced patient of life and barrier to adherence to treatment. 6