The Dry Eye Zone

Rebecca's Blog


Abstract: Do plugs work? Well, we don't really know.

This was a “study of studies”, a review process that analyzed data from ten different clinical trials. The results are surprisingly unhelpful. There’s some indication that plugs did better for symptoms than drops on their own, but otherwise, all the trials were conducted too different to be able to make generalizations about them.

Yet more evidence that we need core outcome sets for dry eye disease, so that studies can be more readily compared with each other!

Br J Ophthalmol. 2018 Oct 18. pii: bjophthalmol-2018-313267. doi: 10.1136/bjophthalmol-2018-313267. [Epub ahead of print]

Punctal occlusion for dry eye syndrome: summary of a Cochrane systematic review.

Ervin AM, Law A, Pucker AD.


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.