Zeitschrift für klinische und experimentelle Ophthalmologie
Offener Zugang

Abstrakt

Efficacy of Punctal Plugs in the Management of Ocular Surface Diseases

Oscar Chen, Sera Choi, Anjali Tannan

Purpose: To evaluate the clinical efficacy of punctal plugs in the management of various ocular surface diseases.

Methods: A retrospective chart review was conducted in an academic teaching center and private clinic between January 2015 and May 2020. Patients who underwent punctal occlusion with punctal plugs were reviewed. Clinical data such as sex and age of the patient, symptoms, plug location, visual acuity, subjective improvement, tear break-up time, corneal stain and complications were obtained. These parameters were evaluated during the initial follow-up (within 60 days of the procedure) and the final follow-up (180-365 days after the procedure). These data were then compared to the patient’s baseline presentation via odds ratio analysis.

Results: A total of 572 patients were included in this study. 385 patients were identified from a private clinic, while 187 were identified from a resident continuity clinic. Dry eye syndrome was the most common indication (440, 79.5%), followed by exposure keratopathy (32, 5.6%), meibomian gland dysfunction (29, 5.0%), sjogren’s syndrome (26, 4.5%), and neurotrophic keratopathy (19, 3.3%). There was a statistically significant improvement in two key symptoms during the first follow-up; eye pain (0.64, p=0.02) and blurry vision (0.70, p=0.04). Visual acuity also showed a statistically significant improvement during the first follow-up (-0.03, p=0.01). The only parameter that continued to show a statistically significant improvement at the final follow-up was eye pain (0.57, p=0.03). None of the clinical findings correlated with dryness, such as tear break-up time or corneal staining showed significant improvement. The most common complications associated with punctal plugs were punctal plug extrusion (168, 29.3%) and epiphora (86, 15%), followed by eye irritation (82, 14.3%).

Conclusion: Punctal plugs offer a simple and effective treatment for improving blurry vision and eye pain associated with various ocular surface diseases. Punctal plugs were shown to improve two key symptoms related to various ocular surface diseases as early as 60 days after installation. Although punctal plugs offer a fast, reversible, and easily implementable treatment for some of the key symptoms of ocular surface diseases, plugs alone do not effectively treat all associated symptoms of these complex ocular surface diseases. Thus, patients would benefit from supplemental and/or adjunctive therapy for a more comprehensive ocular surface disease management.