Comprehensive Review of the Literature on Existing Punctal Plugs for the Management of Dry Eye Disease

Jehangir, Naz; Bever, Greg; Mahmood, Sara; Moshirfar, Majid

doi:10.1155/2016/9312340

Cited by 48 publications

(40 citation statements)

References 83 publications

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“…Marcet et al summarised the evidence from 21 case series and six randomised trials 40. Jehangir et al provided a review of the available punctal plug materials, designs and uses, as well as the complications associated with punctal plug treatment 41. All authors concluded that punctal plugs are an effective and relatively safe means for treating dry eye.…”

Section: Discussionmentioning

confidence: 99%

Punctal occlusion for dry eye syndrome: summary of a Cochrane systematic review

2018

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Dry eye disease is a disorder of the tear film associated with ocular signs and symptoms. Punctal occlusion aids the preservation of natural tears. We conducted a Cochrane systematic review to assess the effectiveness of punctal plugs for managing dry eye. Randomised and quasi-randomised trials were included. The primary outcome was symptomatic improvement (SI) at 2–12 months. Nine databases were searched with no date or language restrictions. Two authors assessed trial quality and extracted data. Summary risk ratios and mean differences were calculated. Ten trials were included. In two trials of punctal plugs versus observation, there was less dryness with punctal plugs. The mean difference (MD) in the dry eye symptom score at 2 months was −28.20 points (95% CI –33.61 to −22.79, range 0 to 105, one trial). Three trials compared punctal plugs with artificial tears. In a pooled analysis of two trials, punctal plug participants reported more SI at 3 months than artificial tear participants (MD −4.20 points, 95% CI −5.87 to −2.53, scales varied from 0 to 6). In the remaining five trials comparing punctal plug placement, acrylic and silicone plugs, or comparing plugs with cyclosporine or pilocarpine, none of the investigators reported a clinically or statistically meaningful difference in symptomatic improvement at 2–12 months. The effectiveness of punctal plugs for treating dry eye symptoms and common signs are inconclusive. Heterogeneity in the type of punctal plug, type and severity of dry eye being treated, and trial methodology confounds the ability to make decisive statements regarding the effectiveness of punctal plugs.

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Section: Discussionmentioning

confidence: 99%

Punctal occlusion for dry eye syndrome: summary of a Cochrane systematic review

2018

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“…[95] Plugs (Figure 2) are classified by the location of insertion, which can include either the puncta or canaliculi (nasolacrimal drainage ducts) and plugs can be either permanently or temporarily inserted. [96] A factor that contributes to the intended duration of usage is the composition of the tear plug, which could be made of degradable collagen, gelatin, as well as non-degradable materials such as silicone, Teflon, and hydromethylacrylate. [95] Even though tear plugs are considered safe and have shown to be effective for maintaining ocular lubrication, some individuals experience complications associated with plug retention rates and infection.…”

Section: Ocular Diseasesmentioning

confidence: 99%

“…[95] It also has been demonstrated that closing the puncta exposes the ocular surface to high levels of pro-inflammatory cytokines in the tears, which can lead to exacerbated symptoms of DED. [96] …”

Section: Ocular Diseasesmentioning

confidence: 99%

Modern Therapeutic Approaches for Noninfectious Ocular Diseases Involving Inflammation

Ratay

Bellotti

Gottardi³

et al. 2017

Adv Healthcare Materials

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Dry eye disease (DED), age-related macular degeneration (AMD), and Uveitis are ocular diseases that significantly affect the quality of life of millions of people each year. In these diseases, the action of chemokines, pro-inflammatory cytokines, and immune cells drives a local inflammatory response that results in ocular tissue damage. Multiple therapeutic strategies have been developed to either address the symptoms or abate the underlying cause of these diseases. Herein, we will review the challenges to deliver drugs to the relevant location in the eye for each of these diseases as well as current and innovative therapeutic approaches that attempt to restore homeostasis within the ocular microenvironment.

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“…Preservative-free artificial tears are preferable for long-term use because preserved formulations may be toxic to the cornea and conjunctival epithelium (Lemp 1994; Pflugfelder 2000; Pucker 2016). Interventions such as bandage contact lenses (physical coverage of the ocular surface), estrogens (hormone replacement), topical corticosteroids (general im-munosuppressant), cyclosporine (immunosuppressant agent that decreases T-cell production), pilocarpine (cholinergic parasympa-theticomimetic agonist), and punctal plugs (lacrimal drainage occlusion device) also have been shown to be effective treatments in selected settings (DEWS 2007a; Freeman 1975; Jehangir 2016 Lemp 1994; Pflugfelder 2000; Sall 2000; Sheppard 2003; Wilson 2003). …”

Section: Introductionmentioning

confidence: 99%

“…Thermal cautery or argon laser achieves permanent occlusion of the puncta (AAO 2003; Dohlman 1978; Lemp 1994). Similar to punctal occlusion, intracanalicular plugs also block tear drainage, though they act by blocking the canalicu-lus instead of the punctum (Jehangir 2016). …”

Section: Introductionmentioning

confidence: 99%

Punctal occlusion for dry eye syndrome

Ervin

Law

Pucker

2017

Cochrane Database of Systematic Reviews

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Background Dry eye syndrome is a disorder of the tear film that is associated with symptoms of ocular discomfort. Punctal occlusion is a mechanical treatment that blocks the tear drainage system in order to aid in the preservation of natural tears on the ocular surface. Objectives To assess the effects of punctal plugs versus no punctal plugs, different types of punctal plugs, and other interventions for managing dry eye. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 11), MEDLINE Ovid (1946 to 8 December 2016), Embase.com (1947 to 8 December 2016), PubMed (1948 to 8 December 2016), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 8 December 2016), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com; last searched 18 November 2012 - this resource is now archived), ClinicalTrials.gov (www.clinicaltrials.gov; searched 8 December 2016), and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en; searched 8 December 2016). We did not use any date or language restrictions in the electronic searches for trials. We also searched the Science Citation Index-Expanded database and reference lists of included studies. The evidence was last updated on 8 December 2016 Selection criteria We included randomized and quasi-randomized controlled trials of collagen or silicone punctal plugs in symptomatic participants diagnosed with aqueous tear deficiency or dry eye syndrome. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We contacted study investigators for additional information when needed. Main results We included 18 trials (711 participants, 1249 eyes) from Austria, Canada, China, Greece, Japan, Mexico, Netherlands, Turkey, the UK, and the USA in this review. We also identified one ongoing trial. Overall we judged these trials to be at unclear risk of bias because they were poorly reported. We assessed the evidence for eight comparisons. Five trials compared punctal plugs with no punctal plugs (control). Three of these trials employed a sham treatment and two trials observed the control group. Two trials did not report outcome data relevant to this review. There was very low-certainty evidence on symptomatic improvement. The three trials that reported this outcome used different scales to measure symptoms. In all three trials, there was little or no improvement in symptom scores with punctal plugs compared with no punctal plugs. Low-certainty evidence from one trial suggested less ocular surface staining in the punctal plug group compared with the no punctal plug group however this difference was small and possibly clinically unimportant (mean difference (MD) in fluorescein staining score -1.50 points, 95% CI -1.88 to -1.12; eyes = 61). Similarly there was a small difference in tear film stability with people in the punctal plug group having more stabili...

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Comprehensive Review of the Literature on Existing Punctal Plugs for the Management of Dry Eye Disease

Cited by 48 publications

References 83 publications

Punctal occlusion for dry eye syndrome: summary of a Cochrane systematic review

Punctal occlusion for dry eye syndrome: summary of a Cochrane systematic review

Modern Therapeutic Approaches for Noninfectious Ocular Diseases Involving Inflammation

Punctal occlusion for dry eye syndrome

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