Punctal plugs are a mainstay in dry eye disease (DED) treatment, yet retention is often an issue. A study in The Ocular Surface reports DED patients and those with both DED and ocular graft-vs.-host-disease (GVHD) who were able to retain their punctal plugs showed improvement in ocular surface disease. However, a majority of patients with both conditions spontaneously lost their punctal plugs within 90 days of placement, which underscores the need for regular follow-up, the researchers noted.

Investigators from Massachusetts Eye and Ear reviewed the records of 864 consecutive patients with DED who were symptomatic despite topical therapy and had silicone punctal plugs placed over an eight-year period. The study compared plug retention rates in both groups and analyzed changes in tear break-up time (TBUT), Schirmer’s test and corneal fluorescein staining scores in plug-retaining patients at the two, six- and 12-month follow-up.

Patients were approximately 58 years old, and 70% were women. In the cohort, 264 patients (31%) had ocular GVHD.

The study found plug retention was significantly lower in ocular GVHD-DED patients compared with DED-only patients. Researchers also observed significant improvement in corneal fluorescein staining scores in plug-retaining DED patients, regardless of their GVHD status, at all follow-up visits.

In patients without GVHD, TBUT was significantly prolonged at the six- and 12-month follow-ups, whereas ocular GVHD patients had a significant TBUT change only at 12 months after plug placement. Also of note: the Schirmer’s score improved significantly in plug-retaining DED only patients at the six- and 12-month follow-up. However, researchers reported no significant Schirmer’s score change in the ocular GVHD-DED patients.

Singh RB, Yung A, Coco G, et al. Efficacy and retention of silicone punctal plugs for treatment of dry eye in patients with and without ocular graft-versus-host-disease. The Ocular Surface. July 30, 2020. [Epub ahead of print].