Punctal plugs for dry eye syndrome

Full citation: Ervin A, Law A, Pucker AD. Punctal occlusion for dry eye syndrome. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD006775. DOI: 10.1002/14651858.CD006775.pub3

What is the aim of this review?
The aim of this Cochrane Review was to determine whether punctal plugs, which are inserted into the tear ducts to block tear drainage, can treat dry eye syndrome. Cochrane review authors searched for all relevant studies and identified 18 clinical trials.

Key messages
It is unclear whether punctal plugs are effective for treating dry eye syndrome. Punctal plugs may be associated with watery eyes, though the evidence for this finding is weak.
What was studied in this review?
Dry eye is a common, chronic condition that affects millions of people around the world. Dry eye sufferers frequently experience burning, foreign body sensation (something in the eye), and blurry vision, which lead them to seek medical care. The typical first-line treatment for dry eye is over-the-counter artificial tears (eye drops). If these fail to relieve symptoms, persons with dry eyes may receive other treatment. Punctal plugs are one type of advanced dry eye treatment; they work by blocking the tear ducts (puncta) of the upper and lower eyelids. Punctal plugs come in several materials, shapes, and sizes.

What are the main results of the review?
This review included 18 trials with 711 participants (1249 eyes), most of whom were women. The trials took place from March 1998 to May 2014 and included participants from Austria, Canada, China, Greece, Japan, Mexico, Netherlands, Turkey, the UK, and the USA. The 18 trials differed greatly in design; they compared different types of punctal plugs and reported results in different ways.

The evidence from this review suggests that punctal plugs do not conclusively improve dry eye symptoms. No type of punctal plug used in the trials we examined was significantly better than another for relieving symptoms of dry eye. It is still unclear if punctal plugs are better than oral treatment (oral pilocarpine) or eye drops such as cyclosporine or artificial tears.

The evidence from this review suggests that punctal plugs may be associated with watery eyes and sometimes with more serious conditions such as infection or swelling in the tear sac (part of the eye where tears drain).

The conclusions of this updated review are similar to the original review published in 2010, though 11 new trials were included.

How up-to-date is this review?
Cochrane review authors searched for studies published up to 8 December 2016.