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Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome: A Report by the American Academy of Ophthalmology.
Ophthalmology. 2015 Aug; 122(8):1681-7.O

Abstract

OBJECTIVE

To review the published literature assessing the efficacy and safety of lacrimal drainage system plug insertion for dry eye in 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 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 approximately 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.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

26038339

Citation

Marcet, Marcus M., et al. "Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome: a Report By the American Academy of Ophthalmology." Ophthalmology, vol. 122, no. 8, 2015, pp. 1681-7.
Marcet MM, Shtein RM, Bradley EA, et al. Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome: A Report by the American Academy of Ophthalmology. Ophthalmology. 2015;122(8):1681-7.
Marcet, M. M., Shtein, R. M., Bradley, E. A., Deng, S. X., Meyer, D. R., Bilyk, J. R., Yen, M. T., Lee, W. B., & Mawn, L. A. (2015). Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome: A Report by the American Academy of Ophthalmology. Ophthalmology, 122(8), 1681-7. https://doi.org/10.1016/j.ophtha.2015.04.034
Marcet MM, et al. Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome: a Report By the American Academy of Ophthalmology. Ophthalmology. 2015;122(8):1681-7. PubMed PMID: 26038339.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome: A Report by the American Academy of Ophthalmology. AU - Marcet,Marcus M, AU - Shtein,Roni M, AU - Bradley,Elizabeth A, AU - Deng,Sophie X, AU - Meyer,Dale R, AU - Bilyk,Jurij R, AU - Yen,Michael T, AU - Lee,W Barry, AU - Mawn,Louise A, Y1 - 2015/05/30/ PY - 2015/04/27/received PY - 2015/04/27/revised PY - 2015/04/27/accepted PY - 2015/6/4/entrez PY - 2015/6/4/pubmed PY - 2015/10/17/medline SP - 1681 EP - 7 JF - Ophthalmology JO - Ophthalmology VL - 122 IS - 8 N2 - OBJECTIVE: To review the published literature assessing the efficacy and safety of lacrimal drainage system plug insertion for dry eye in 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 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 approximately 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. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/26038339/Safety_and_Efficacy_of_Lacrimal_Drainage_System_Plugs_for_Dry_Eye_Syndrome:_A_Report_by_the_American_Academy_of_Ophthalmology_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(15)00417-0 DB - PRIME DP - Unbound Medicine ER -