More evidence is emerging that punctal plug insertion can lead to success in warding off ocular surface damage. A new Australian study shows that the devices improve both subjective and objective measures of ocular surface disease.1 The randomized, controlled trial looked at 48 subjects from glaucoma clinics. Subjects’ ocular surface disease index, tear film breakup time, Oxford cornea score and tear osmolarity were all measured to assess ocular surface status. The changes to the patients’ eyes after punctal plug implantation were significant after six weeks of wear.

Additionally, the researchers noted that the intraocular pressures were reduced in patients who received the plugs and also had symptomatic ocular surface disease using prostaglandin analog monotherapy. Also, in regards to the patients’ glaucoma, a subgroup analysis showed efficacy regardless of prostaglandin preservative status or lubricant drop use.

The study was published in the April edition of the journal Clinical & Experimental Ophthalmology. Although the plugs were generally well tolerated in this study, extrusion occurred in 8.5% of cases and epiphora increased in 6.5% eyes.

Punctal plugs have several uses in eye care, as this study highlights. For some cases, doctors have even suggested using punctal plugs as first-line therapy. “Patients with neurotrophic dry eye are ideal candidates for punctal occlusion, as are patients with contact lens intolerance due to early DED,” wrote Paul Karpecki, OD, in a 2017 Review of Optometry piece.2 “Neurotrophic dry eye, often caused by conditions such as herpes zoster ophthalmicus or diabetes, affects patient’s nerves, resulting in poor communication between the lacrimal functional unit and the brain."

1. Sherwin J, Ratnarajan G, Elaphi B, et al. Effect of a punctal plug on ocular surface disease in patients using topical prostaglandin analogues: a randomised controlled trial. Clin Exp Ophthalmol. April 19, 2018. Accessed May 11, 2018.
2. Karpecki P. Plug into dry eye therapy. Rev Optom. 2017;154(3):103-4.