Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome OTA

A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Oculoplastics & Orbit Panel and Cornea & Anterior Segment Disorders Panel: Marcus M. Marcet, MD,¹ Roni M. Shtein, MD, MS,² Elizabeth A. Bradley, MD,³ Sophie X. Deng, MD, PhD,⁴ Dale R. Meyer, MD,⁵ Jurij R. Bilyk, MD,⁶ Michael T. Yen, MD,⁷ W. Barry Lee, MD,⁸ Louise A. Mawn, MD⁹

Ophthalmology, August 2015, Vol 122, 1681-1687 © 2015 by the American Academy of Ophthalmology. Click here for free access to the OTA.

Reviewed for currency: 2020

Objective: To review the published literature assessing the efficacy and safety of lacrimal drainage system plug insertion for dry eye n adults.

Methods: Literature searches of the PubMed and Cochrane Library databases were last conducted on March 9, 2015 without date restrictions, and were limited to English language abstracts. The searches retrieved 309 unique citations. The primary authors reviewed the titles and abstracts. Inclusion criteria specified reports that provided original data on plugs for the treatment of dry eyes in at least 25 patients. Fifty-three studies of potential relevance were assigned to full-text review. The 27 studies that met the inclusion criteria underwent data abstraction by the panels. Abstracted data included study characteristics, patient characteristics, plug type, insertion technique, treatment response, and safety information. All studies were observational and were rated by a methodologist as level II or III evidence.

Results: The plugs included punctal, intracanalicular, and dissolving types. Fifteen studies reported metrics of improvement in dry eye symptoms, ocular-surface status, artificial tear use, contact lens comfort, and tear break-up time. Twenty-five studies included safety data. Plug placement resulted in ≥50% improvement of symptoms, improvement in ocular-surface health, reduction in artificial tear use, and improved contact lens comfort in patients with dry eye. Serious complications from plugs were infrequent. Plug loss was the most commonly reported problem with punctal plugs, occurring on average in 40% of patients. Overall, among all plug types, approximately 9% of patients experienced epiphora and 10% required removal because of irritation from the plugs. Canaliculitis was the most commonly reported problem for intracanalicular plugs and occurred in about 8% of patients. Other complications were reported in less than 4% of patients on average and included tearing, discomfort, pyogenic granuloma, and dacryocystitis.

Conclusions: On the basis of level II and III evidence in these studies, plugs improve the signs and symptoms of moderate dry eye that are not improved with topical lubrication, and they are well tolerated. There are no level I studies that describe the efficacy or safety of lacrimal drainage system plugs.

¹Department of Ophthalmology, University of Hong Kong, Cyberport, Hong Kong
²Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
³Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
⁴Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
⁵Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York
⁶Wills Eye Hospital, Philadelphia, Pennsylvania
⁷Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
⁸Piedmont Hospital and Eye Consultants of Atlanta, Atlanta, Georgia
⁹Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee