Punctal Plugs Treat Some — Not All — Symptoms of Some Ocular Surface Diseases

MACRO: Shiny clear brown eye twitches before application of eye drops to sooth irritation. Mascara covered lashes flinch when droplet hits eyeball. Female applying water drops to eyeball.
While the devices help manage blurry vision and pain, they should not be used as standalone treatments.

This article is part of Ophthalmology Advisor’s conference coverage from the 2021 meeting of American Society of Cataract and Refractive Surgery (ASCRS), held in Las Vegas from July 23 to 27, 2021. The team at Ophthalmology Advisor will be reporting on a variety of research presented by the cataract and refractive surgery experts at ASCRS. Check back for more from the ASCRS 2021 Meeting.


Punctal plugs improve blurry vision and eye pain, but not other symptoms associated with ocular surface diseases (OSD), according to research presented at the American Society of Cataract and Refractive Surgery (ASCRS) 2021 meeting in Las Vegas, held July 23 to 27. Researchers say the devices should not be used as a stand-alone treatment.

In a retrospective cohort study, researchers evaluated the safety and efficacy of punctal plugs as a way to treat OSD. Participants included patients from 2 departments at the Rush University Medical Center, Eye Center Physicians and the University Ophthalmology Associates who underwent punctal occlusion between 2015 and 2020. 

Study outcomes included subjective symptom improvement, visual acuity, ocular surface symptoms, tear film breakup time, and fluorescein corneal stain. 

The total cohort included 572 adult patients, with no significant difference in clinical outcomes based on provider, clinic, gender, or clinical indication for plug placement. 

At the first follow-up visit, investigators saw a statistically significant improvement in 2 subjective dry eye symptoms: eye pain and blurry vision (0.64 and 0.70, respectively). At the final follow-up, only eye pain improvements were still statistically significant (0.57). Compared with baseline, there were no statistically significant improvements in either corneal staining or tear film breakup time. 

The most common complication was epiphora, seen in 15% of participants. 

“Punctal plugs provided clinically significant improvement in both blurry vision and eye pain,” according to the research. “However, there was no significant improvement in signs of dry eyes…Therefore, punctal plugs may serve as a treatment option for some ocular surface diseases, but not as a stand-alone treatment.” 

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Chen O, Tannan A, Choi S. Efficacy of punctal plugs in the management of ocular surface diseases. Poster presented at: 2021 ASCRS Annual Meeting; July 2021; Las Vegas, NV. Abstract 73756.