title: Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome: A Report by the American Academy of Ophthalmology.
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.affiliation: Department of Ophthalmology, University of Hong Kong, Cyberport, Hong Kong.
authors.forename: Marcus M
authors.initials: MM
authors.lastname: Marcet
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan.
authors.forename: Roni M
authors.initials: RM
authors.lastname: Shtein
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bradley
authors.affiliation: Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
authors.forename: Sophie X
authors.initials: SX
authors.lastname: Deng
authors.affiliation: Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York.
authors.forename: Dale R
authors.initials: DR
authors.lastname: Meyer
authors.affiliation: Wills Eye Hospital, Philadelphia, Pennsylvania.
authors.forename: Jurij R
authors.initials: JR
authors.lastname: Bilyk
authors.affiliation: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Yen
authors.affiliation: Piedmont Hospital and Eye Consultants of Atlanta, Atlanta, Georgia.
authors.forename: W Barry
authors.initials: WB
authors.lastname: Lee
authors.affiliation: Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Mawn
mesh_terms: D000047:Academies and Institutes / Q000458:organization & administration; D015352:Dry Eye Syndromes / Q000628:therapy*; D004869:Equipment Safety; D006801:Humans; D007765:Lacrimal Apparatus / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation*; D009885:Ophthalmology / Q000458:organization & administration*; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012826:Silicone Elastomers; D013673:Technology Assessment, Biomedical; D014481:United States
chemical_list: D012826:Silicone Elastomers