Punctal Plugging Trial Shows Benefit in Refractory Dry Eye

Key Takeaways

• Punctal plugging was associated with improvement in OSDI and reduced SICCA corneal staining versus sham over follow-up.
• By 12 and 24 weeks, 70% achieved mild or lower OSDI scores.
• Reported complications included plug dislodgement and skin irritation, and more than 90% of participants were satisfied with induced epiphora.

In a sham-controlled trial of 66 patients with refractory dry eye disease and ocular surface damage, punctal plugging was associated with better symptoms than sham through follow-up. Benefit was seen in this 24-week comparison, with differences still present at later assessments. The abstract describes silicone plugs placed in both upper and lower eyelids to induce tear overflow in the treatment group. Participants had refractory disease accompanied by ocular surface damage. Improvement was reported in both subjective symptoms and ocular surface findings across follow-up.

The trial was a 24-week patient-masked randomized sham-controlled trial enrolling 66 participants with refractory dry eye disease and ocular surface damage. The treatment group received silicone punctal plugs in both upper and lower eyelids to induce tear overflow, while controls underwent a matched sham procedure. Outcomes were tracked with OSDI and the SICCA corneal staining score. Baseline means were 34.1 ± 11.7 for OSDI and 1.5 ± 0.7 for corneal staining.

Compared with sham, the treatment group showed significant improvement in OSDI and reduced corneal staining, with reported between-group comparisons at p < 0.05. Differences were observed by 3 weeks after randomization and increased further over follow-up. At the 12- and 24-week assessments, 70% achieved mild or lower OSDI scores. Patient-reported symptom improvement was accompanied by reduced corneal staining over the study period.

Complications in the treatment group included plug dislodgement in 39.4% and skin irritation in 33.3%. More than 90% of participants in the treatment arm reported satisfaction with the induced epiphora despite these events. The authors described punctal plugging as a potential adjunctive option that warrants careful application and longer-term evaluation.