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Nasolacrimal Lavage as a Treatment for Ocular Surface Toxic Soup Syndrome
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Punctal occlusion for dry eye syndrome.

Ann-Margret Ervin1, Andrew Law, Andrew D Pucker

  • 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6146, Baltimore, Maryland, USA, 21205.

The Cochrane Database of Systematic Reviews
|June 27, 2017
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Summary

Punctal plugs offer minimal symptom improvement for dry eye syndrome, with inconclusive evidence on their effectiveness compared to no treatment or artificial tears. Adverse events like epiphora are common.

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Area of Science:

  • Ophthalmology
  • Dry Eye Disease Management

Background:

  • Dry eye syndrome is a common ocular surface disorder characterized by discomfort due to tear film dysfunction.
  • Punctal occlusion, a treatment for dry eye, involves blocking tear drainage to conserve natural tears.

Purpose of the Study:

  • To evaluate the efficacy of punctal plugs in managing dry eye symptoms and signs.
  • To compare punctal plugs against no treatment, artificial tears, and other interventions.

Main Methods:

  • A systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
  • Searched multiple databases including CENTRAL, MEDLINE, Embase, PubMed, LILACS, ClinicalTrials.gov, and ICTRP.
  • Included trials involving collagen or silicone punctal plugs in symptomatic dry eye patients.

Main Results:

  • Very low-certainty evidence suggests minimal symptomatic improvement with punctal plugs compared to no treatment.
  • Low-certainty evidence indicates small, possibly unimportant, differences in ocular surface staining and tear film stability.
  • Adverse events such as epiphora, itching, and lid swelling were reported with punctal plug use.

Conclusions:

  • The effectiveness of punctal plugs for dry eye signs and symptoms remains inconclusive, despite updated evidence.
  • Heterogeneity in trial methodology and dry eye characteristics limits definitive conclusions.
  • While generally safe, punctal plugs can cause adverse effects like epiphora and dacryocystitis.