Punctal occlusion for dry eye syndrome

Abstract

Background Dry eye syndrome is a disorder of the tear film and is associated with symptoms of ocular discomfort. Punctal occlusion is a mechanical treatment in which the tear drainage system is blocked in order to aid in the preservation of natural tears on the ocular surface. Objectives The objective of this review was to assess the safety and efficacy of punctal plugs for the management of dry eye. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2010, Issue 6), MEDLINE (January 1950 to June 2010), EMBASE (January 1980 to June 2010), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2010), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (http://clinicaltrials.gov). We also searched the Science Citation Index-Expanded database and reference lists of included studies. There were no language or date restrictions in the search for trials. The electronic databases were last searched on 21 June 2010. 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. Main results Seven randomized controlled trials including 305 participants (601 eyes) met the inclusion criteria and are summarized in this review. We did not perform meta-analysis due to appreciable variability in interventions and follow-up intervals. Although punctal plugs provided symptomatic improvement and clinical outcomes also improved from baseline measures, few studies demonstrated a benefit of punctal plugs over the comparison intervention. Reported adverse effects included epiphora (overflow of tears), foreign body sensation, eye irritation, and spontaneous plug loss. Authors’ conclusions This systematic review shows a relative scarcity of controlled clinical trials assessing the efficacy of punctal occlusion therapy in dry eye. Although the evidence is very limited, the data suggest that silicone plugs can provide symptomatic relief in severe dry eye. Moreover, temporary collagen plugs appear similarly effective to silicone plugs on a short-term basis.

A systematic review of non-pharmacological interventions for primary Sjögren’s syndrome

“…These studies suggest that punctal plugs are effective for outcomes of body function and some activity outcomes. This is in line with a Cochrane review of punctal plugs in dry eyes [ 37 ], which was not pSS specific. The oral lubrication devices, psychodynamic therapy and acupuncture did not provide evidence of significant benefit.…”

A systematic review of non-pharmacological interventions for primary Sjögren’s syndrome

“…These studies suggest that punctal plugs are effective for outcomes of body function and some activity outcomes. This is in line with a Cochrane review of punctal plugs in dry eyes [ 37 ], which was not pSS specific. The oral lubrication devices, psychodynamic therapy and acupuncture did not provide evidence of significant benefit.…”

EULAR recommendations for the management of Sjögren's syndrome with topical and systemic therapies

“…Other therapeutic interventions may be considered after failure of the above-mentioned therapies, including topical and systemic therapies. A recent Cochrane SLR reviewing the use of plugs for dry eye syndrome45 found that the evidence was very limited, and concluded that improvements in subjective and objective ocular outcomes were inconclusive. Two studies have been carried out in primary-2002 SjS patients: the first found no significant differences between groups (insertion of plugs vs AT),46 and the second reported improvement in only two of four ocular outcomes evaluated 47.…”

Efficacy and safety of topical and systemic medications: a systematic literature review informing the EULAR recommendations for the management of Sjögren’s syndrome

“…In a prospective study, Egrilmez et al 20 reported improvement in two out of four ocular tests with respect to baseline 12 months after inserting plugs. A recent Cochrane SLR reviewed the use of plugs for dry eye syndrome50 and found that the evidence was very limited and improvements in symptoms and ocular tests were inconclusive.…”

A systematic review of non-pharmacological interventions for primary Sjögren’s syndrome

“…These studies suggest that punctal plugs are effective for outcomes of body function and some activity outcomes. This is in line with a Cochrane review of punctal plugs in dry eyes [ 37 ], which was not pSS specific. The oral lubrication devices, psychodynamic therapy and acupuncture did not provide evidence of significant benefit.…”

EULAR recommendations for the management of Sjögren's syndrome with topical and systemic therapies

“…Other therapeutic interventions may be considered after failure of the above-mentioned therapies, including topical and systemic therapies. A recent Cochrane SLR reviewing the use of plugs for dry eye syndrome45 found that the evidence was very limited, and concluded that improvements in subjective and objective ocular outcomes were inconclusive. Two studies have been carried out in primary-2002 SjS patients: the first found no significant differences between groups (insertion of plugs vs AT),46 and the second reported improvement in only two of four ocular outcomes evaluated 47.…”

Efficacy and safety of topical and systemic medications: a systematic literature review informing the EULAR recommendations for the management of Sjögren’s syndrome

“…In a prospective study, Egrilmez et al 20 reported improvement in two out of four ocular tests with respect to baseline 12 months after inserting plugs. A recent Cochrane SLR reviewed the use of plugs for dry eye syndrome50 and found that the evidence was very limited and improvements in symptoms and ocular tests were inconclusive.…”

A systematic review of non-pharmacological interventions for primary Sjögren’s syndrome

“…These studies suggest that punctal plugs are effective for outcomes of body function and some activity outcomes. This is in line with a Cochrane review of punctal plugs in dry eyes [ 37 ], which was not pSS specific. The oral lubrication devices, psychodynamic therapy and acupuncture did not provide evidence of significant benefit.…”

EULAR recommendations for the management of Sjögren's syndrome with topical and systemic therapies

“…Other therapeutic interventions may be considered after failure of the above-mentioned therapies, including topical and systemic therapies. A recent Cochrane SLR reviewing the use of plugs for dry eye syndrome45 found that the evidence was very limited, and concluded that improvements in subjective and objective ocular outcomes were inconclusive. Two studies have been carried out in primary-2002 SjS patients: the first found no significant differences between groups (insertion of plugs vs AT),46 and the second reported improvement in only two of four ocular outcomes evaluated 47.…”

Efficacy and safety of topical and systemic medications: a systematic literature review informing the EULAR recommendations for the management of Sjögren’s syndrome

“…In a prospective study, Egrilmez et al 20 reported improvement in two out of four ocular tests with respect to baseline 12 months after inserting plugs. A recent Cochrane SLR reviewed the use of plugs for dry eye syndrome50 and found that the evidence was very limited and improvements in symptoms and ocular tests were inconclusive.…”