What your patient might ask you…

Which is better for my dry eye, plugs or tears?

A new review published in the British Journal of Ophthalmology examined 10 different studies involving punctal plugs. The authors sought out to determine the effectiveness of punctal plugs based on where they were placed, what material was better, and against other dry eye treatments. Below is a quick synopsis on what they found.

Plugs vs observation…winner = plugs!
Two studies compared the use of punctal plugs to observation and patient symptoms improved with punctal plugs.

Plugs vs artificial tears….winner = plugs!
Three studies compared the use of artificial tears to punctal plugs and found patient symptoms improved more with punctal plugs in two of the studies.

Plugs in the upper vs the lower puncta…winner = similar results.
One study found “there was a 7% increase in symptomatic improvement favoring punctal plugs in the upper puncta, however this difference was not statistically significant.”

Collagen plugs vs silicone plugs…winner = similar results.
One study found at the 6 month follow-up there was no significant difference.

Plugs vs cyclosporin…winner = a combo of both.
One study looked at plugs vs Restasis vs a combo of both plugs and Restasis. The combo therapy “produced the greatest overall improvements and was better than plugs alone in decreasing artificial tear use at 6 months.”

Side note: There are many caveats to these studies, too much to go into detail here. Give the study a read if you want to see the other data on TBUT improvement, Schirmer scores, ocular surface staining etc. (via)

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