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 “Plugs are generally well tolerated,” said Dr. Marcus Marcet, an
ophthalmologist at the University of Hong Kong and the study’s first
author. “Overall the extent of relief depends on both the type of
dry eye and the type of plug.”
Patients with dry eyes who might benefit from plugs are those who
have already tried eye drops and gels but still have itchy, red,
painful eyes, blurred vision and the sensation of a foreign body in
the eye, Marcet and his team note in the journal Ophthalmology.
About 20 to 30 million people in the U.S. suffer mild dry eyes and 9
million have moderate to severe dry eyes, Marcet notes.
“Studies have shown that dry eye significantly impacts patients’
quality of life,” he told Reuters Health in an email. “If untreated,
more severe cases of dry eye can result in vision loss due to
corneal scarring.”
His team’s review, sponsored by the American Academy of
Ophthalmology, looked at data on tiny semi-permanent punctal plugs
(which are placed in the tear duct) and intracanalicular plugs
(inserted deeper into the eye duct channel), and dissolvable plugs.
Punctal plugs are usually made from silicone or acrylic polymer,
while dissolvable plugs are made from collagen or synthetic
material.
Both types of semi-permanent plugs offered long-term help for dry
eyes, though a higher percentage of people in studies with
intracanalicular plugs had more infections near the inner corner of
the eyelid than did the people in punctal or dissolvable plug
studies.
The few studies on dissolvable plugs reported temporary decreases in
symptoms.
“The plugs are meant to slow the drainage of tears away from the eye
surface (which is part of the natural tear circulation) . . . so
even if your body isn’t making enough tears, we can at least try to
maximize the moisturizing effect of the tears you do have,” said Dr.
Roni Shtein, a coauthor on the paper from the University of Michigan
in Ann Arbor.
Out of the 27 observational studies in the review, 15 measured
improvements in dry eye symptoms, eye surface status, artificial
tear use, contact lens comfort and tear break-up time. Twenty-five
studies reported on safety.
The plugs helped relieve dry eye symptoms at least 50 percent of the
time, also improving eye surface health, reducing artificial tear
use and improving contact lens comfort.
Serious complications from plugs were infrequent, according to the
researchers.
But 40 percent of the 1,485 people with punctal plugs reported plug
loss or movement.
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Other complications with the different plugs included extra tearing
in 9 percent of people and removal because of irritation in 10
percent.
“The most dangerous side effect is the development of severe
inflammation or infection around the plug . . . . this is quite
rare, and in our review seems to be disproportionately common with (intracanalicular
plugs),” Shtein wrote in an email.
Shtein noted that each study used slightly different measurements
and reporting methods, making it difficult to compare results. There
were also no randomized, controlled trials, which are the gold
standard for studying medical devices.
Dr. Kristin Hammersmith, a corneal surgeon at Wills Eye Hospital in
Philadelphia who was not involved in the study, said the review
showed the effectiveness and relative safety of plugs.
“This paper kind of puts together what the level of evidence is for
this being a good modality,” said Hammersmith. “But the kind of
randomized control trials we’re taught to really give a lot of
credence to in medicine don’t exist for punctal plugs… probably
because people have used them for a long time, they seem to work and
it hasn’t been too exciting for individuals or industries to sponsor
big randomized control trials comparing this to not using plugs.”
Dry eyes are more common as people age and in women, Hammersmith
said in a phone interview. She advises patients to try warm
compresses on the eye and be careful about eyelid hygiene. Topical
cyclosporine is another option.
“The patients who do very well with (plugs) are those with busy
lifestyles, who have a hard time being compliant with drops, and
it’s just easier if the tears are there longer and they don’t have
to do anything else,” said Hammersmith.
SOURCE: http://bit.ly/1FYeLVz Ophthalmology, online May 30, 2015.
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