Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome

Marcet, Marcus M.; Shtein, Roni M.; Bradley, Elizabeth; Deng, Sophie X.; Meyer, Dale R.; Bilyk, Jurij R.; Yen, Michael T.; Lee, W. Barry; Mawn, Louise A.

doi:10.1016/j.ophtha.2015.04.034

Cited by 42 publications

(29 citation statements)

References 32 publications

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“…However, Mazow et al 13 reported that intracanalicular type plugs were associated with a higher rate of complications, including canaliculitis, when compared with collared punctal plugs. One systematic literature review further revealed that canaliculitis occurred in approximately 8% of patients who underwent intracanalicular plugs and 0%–5.6% of patients who underwent punctal plugs 14. In our study, 82% of plug-related canaliculitis were associated with intracanalicular plugs, and 18% were related with punctal plugs.…”

Section: Discussionsupporting

confidence: 56%

“…Freedman et al 3 reported that women represent 92% of secondary canaliculitis cases in a review study. This strong propensity may be due to female predominance of dry eye requiring lacrimal plug insertion,14 physiological or hormonal influence of women during menopause or the frequent use of makeup (cosmetics) 15 16. Tiny cosmetics may deposit on the intracanalicular plugs and further occlude the canaliculus and promote the anaerobic bacterial growth, predisposing to canaliculitis.…”

Section: Discussionmentioning

confidence: 99%

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Clinical features, microbiological profiles and treatment outcome of lacrimal plug-related canaliculitis compared with those of primary canaliculitis

Huang

Tsai

et al. 2015

Br J Ophthalmol

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Clinical features, microbiological profiles and treatment outcome of lacrimal plug-related canaliculitis compared with those of primary canaliculitis

Huang

Tsai

et al. 2015

Br J Ophthalmol

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“…Lacrimal drainage system plugs are known to improve the signs and symptoms of moderately dry eyes that are not improved with topical lubrication, and they are usually well-tolerated [10]. They can be classified according to their location (punctal versus canalicular) and their duration of placement (short versus extended duration).…”

Section: Introductionmentioning

confidence: 99%

“…They can be classified into temporary short duration plugs that are usually made of animal collagen and last for 4–14 days, and temporary extended duration plugs that last from 2 to 6 months and they are made of different materials that include silicone, hydrogel, polydioxanone and acrylic. The temporary extended duration punctal plugs are the type used following refractive surgery [10–13]. …”

Section: Introductionmentioning

confidence: 99%

Comparison Between Botulinum Toxin A Injection and Lacrimal Punctal Plugs for the Control of Post-LASIK Dry Eye Manifestations: A Prospective Study

Fouda

Mattout

2017

Ophthalmol Ther

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IntroductionLaser in situ keratomelieusis (LASIK) is one of the commonest refractive procedures performed nowadays. The dry eye problem is nearly universal in all patients after LASIK and it can be so annoying that the post-operative patient satisfaction is sometimes precluded. Conventional treatment includes the use of artificial tears. Alternative methods such as punctal plugs and botulinum toxin injection can be used for the management of post-LASIK dry eye. The aim of this study is to compare botulinum toxin injection in the orbicularis muscle to lacrimal punctal plugs for the control of post-LASIK dry eye manifestations.MethodsThis is a prospective study that included 60 patients who had LASIK eye surgery for correction of refractive errors. Patients were randomly assigned to one of three methods of dry eye management; the first method was conventional medical treatment with preservative-free tear substitutes only (group A: 20 patients = 40 eyes); the second method was intraoperative injection of botulinum toxin A (BTA) in the orbicularis muscle below the lower punctum of both eyes (group B: 20 patients = 40 eyes) and the third method was intraoperative insertion of temporary extended duration silicone punctal plugs in the lower punctum of both eyes (group C: 20 patients = 40 eyes).ResultsIn the first follow-up visit after 2 weeks, the two test groups (B, C) showed a statistically significant increase in both tear film break up time (TBUT) and Schirmer test score with a decrease in the OSDI score and daily frequency of lubricants used in comparison to the control group A. These differences were maintained in the next follow-up visit but they became statistically insignificant at the 3rd and 6th post-operative months. Complications were encountered more in the punctal plug patients (60%) than in BTA patients (25%) and this difference was statistically significant.ConclusionThe use of BTA injection to control dry eye symptoms by inducing temporary punctal ectropion is an effective method to improve patient satisfaction after LASIK eye surgery. It has higher level of patient satisfaction and fewer complications in comparison to punctal plugs or topical standard dry eye treatment.

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“…Hamano and Yellepeddi et al reviewed punctal plug types and the ways in which punctal plugs are used for treating dry eye 38 39. 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.…”

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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Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome

Cited by 42 publications

References 32 publications

Clinical features, microbiological profiles and treatment outcome of lacrimal plug-related canaliculitis compared with those of primary canaliculitis

Clinical features, microbiological profiles and treatment outcome of lacrimal plug-related canaliculitis compared with those of primary canaliculitis

Comparison Between Botulinum Toxin A Injection and Lacrimal Punctal Plugs for the Control of Post-LASIK Dry Eye Manifestations: A Prospective Study

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

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