Punctal plugs are but one arrow in the quiver of dry eye disease (DED) treatments, but new research shows that they’re hitting their marks at least as well as others. A Cochrane systematic review recently published in the British Journal of Ophthalmology took into account 10 trials of the devices’ efficacy. Five trials examined whether the plugs were more effective depending on placement and material of the plugs themselves, two compared them with observation alone and three compared them with artificial tear use.1
The investigators found that, in two studies, patients who had plugs showed greater improvement than those who were merely observed. In the three studies that compared them with artificial tears, two showed greater symptomatic improvements with the plugs than with tears alone, after three months. The other five concluded no meaningful difference between plugs of different materials or that were placed in different locations.
Earlier research has been critical of punctal plugs. For instance, in the 2017 Tear Film Ocular Society Dry Eye Workshop II (TFOS DEWS II) publication, the devices were listed as a “second tier” option and pointed to a dearth of studies that “demonstrated a benefit […] over a comparison intervention.” The report also noted, “To date, there are no large scale, Level 1 studies to support the contention that punctal occlusion of any form is effective in the management of DED.”2
This meta-analysis is based on studies that used a variety of different methods and, hence, makes its findings inconclusive, except to suggest that punctal plugs deserve deeper investigation from researchers.
1. Ervin A, Law A, Pucker A. Punctal occlusion for dry eye syndrome: summary of a Cochrane systemic review. Br J Ophthalmol. January 2019. [Epub ahead of print].
2. Jones L, Downie L, Korb D. Tear Film Ocular Society Dry Eye Workshop II – Management and therapy. www.tfosdewsreport.org/report-management_and_therapy/147_36/en/. July 2017. Accessed January 17, 2019.