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Punctal occlusion for dry eye syndrome: summary of a Cochrane systematic review.
Br J Ophthalmol. 2019 03; 103(3):301-306.BJ

Abstract

Dry eye disease is a disorder of the tear film associated with ocular signs and symptoms. Punctal occlusion aids the preservation of natural tears. We conducted a Cochrane systematic review to assess the effectiveness of punctal plugs for managing dry eye. Randomised and quasi-randomised trials were included. The primary outcome was symptomatic improvement (SI) at 2-12 months. Nine databases were searched with no date or language restrictions. Two authors assessed trial quality and extracted data. Summary risk ratios and mean differences were calculated. Ten trials were included. In two trials of punctal plugs versus observation, there was less dryness with punctal plugs. The mean difference (MD) in the dry eye symptom score at 2 months was -28.20 points (95% CI -33.61 to -22.79, range 0 to 105, one trial). Three trials compared punctal plugs with artificial tears. In a pooled analysis of two trials, punctal plug participants reported more SI at 3 months than artificial tear participants (MD -4.20 points, 95% CI -5.87 to -2.53, scales varied from 0 to 6). In the remaining five trials comparing punctal plug placement, acrylic and silicone plugs, or comparing plugs with cyclosporine or pilocarpine, none of the investigators reported a clinically or statistically meaningful difference in symptomatic improvement at 2-12 months. The effectiveness of punctal plugs for treating dry eye symptoms and common signs are inconclusive. Heterogeneity in the type of punctal plug, type and severity of dry eye being treated, and trial methodology confounds the ability to make decisive statements regarding the effectiveness of punctal plugs.

Authors+Show Affiliations

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA aervin@jhu.edu.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Systematic Review

Language

eng

PubMed ID

30337332

Citation

Ervin, Ann-Margret, et al. "Punctal Occlusion for Dry Eye Syndrome: Summary of a Cochrane Systematic Review." The British Journal of Ophthalmology, vol. 103, no. 3, 2019, pp. 301-306.
Ervin AM, Law A, Pucker AD. Punctal occlusion for dry eye syndrome: summary of a Cochrane systematic review. Br J Ophthalmol. 2019;103(3):301-306.
Ervin, A. M., Law, A., & Pucker, A. D. (2019). Punctal occlusion for dry eye syndrome: summary of a Cochrane systematic review. The British Journal of Ophthalmology, 103(3), 301-306. https://doi.org/10.1136/bjophthalmol-2018-313267
Ervin AM, Law A, Pucker AD. Punctal Occlusion for Dry Eye Syndrome: Summary of a Cochrane Systematic Review. Br J Ophthalmol. 2019;103(3):301-306. PubMed PMID: 30337332.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Punctal occlusion for dry eye syndrome: summary of a Cochrane systematic review. AU - Ervin,Ann-Margret, AU - Law,Andrew, AU - Pucker,Andrew D, Y1 - 2018/10/18/ PY - 2018/09/21/received PY - 2018/09/27/revised PY - 2018/09/28/accepted PY - 2018/10/20/pubmed PY - 2019/10/28/medline PY - 2018/10/20/entrez KW - lacrimal drainage KW - ocular surface KW - tears KW - treatment medical SP - 301 EP - 306 JF - The British journal of ophthalmology JO - Br J Ophthalmol VL - 103 IS - 3 N2 - Dry eye disease is a disorder of the tear film associated with ocular signs and symptoms. Punctal occlusion aids the preservation of natural tears. We conducted a Cochrane systematic review to assess the effectiveness of punctal plugs for managing dry eye. Randomised and quasi-randomised trials were included. The primary outcome was symptomatic improvement (SI) at 2-12 months. Nine databases were searched with no date or language restrictions. Two authors assessed trial quality and extracted data. Summary risk ratios and mean differences were calculated. Ten trials were included. In two trials of punctal plugs versus observation, there was less dryness with punctal plugs. The mean difference (MD) in the dry eye symptom score at 2 months was -28.20 points (95% CI -33.61 to -22.79, range 0 to 105, one trial). Three trials compared punctal plugs with artificial tears. In a pooled analysis of two trials, punctal plug participants reported more SI at 3 months than artificial tear participants (MD -4.20 points, 95% CI -5.87 to -2.53, scales varied from 0 to 6). In the remaining five trials comparing punctal plug placement, acrylic and silicone plugs, or comparing plugs with cyclosporine or pilocarpine, none of the investigators reported a clinically or statistically meaningful difference in symptomatic improvement at 2-12 months. The effectiveness of punctal plugs for treating dry eye symptoms and common signs are inconclusive. Heterogeneity in the type of punctal plug, type and severity of dry eye being treated, and trial methodology confounds the ability to make decisive statements regarding the effectiveness of punctal plugs. SN - 1468-2079 UR - https://www.unboundmedicine.com/medline/citation/30337332/Punctal_occlusion_for_dry_eye_syndrome:_summary_of_a_Cochrane_systematic_review_ L2 - http://bjo.bmj.com/cgi/pmidlookup?view=long&pmid=30337332 DB - PRIME DP - Unbound Medicine ER -