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Tip of the Month
Tip of the month - The insertion of a punctal plug improves ocular comfort and results in a modest reduction of IOP in patients with glaucoma who are using topical medication
The insertion of a punctal plug improves ocular comfort and results in a modest reduction of IOP in patients with glaucoma who are using topical medication

Publishing date: May 2018

Tip Editor: John Salmon
Tip reviewer: Roger Hitchings


The Science behind the Tip

Patients with ocular hypertension and chronic glaucoma have a higher prevalence of ocular surface disease (OSD) than matched individuals in the normal population (1). Duration of  topical therapy, exposure to preservatives, increasing age and worse severity of glaucoma have been associated with severity of OSD (2). The use of punctal plugs is an important therapeutic consideration in these patients. A recent comprehensive review confirms that punctal plugs can improve markers of OSD (3).

In patients on intraocular pressure-lowering eyedrops, the insertion of a punctal plug also results in a modest reduction of IOP (4).  Plugs prevent topically instilled drops from leaving the eye quickly, increasing the penetration into the eye and therefore improving the efficacy of the drug.

Contributor: John F Salmon MD - Oxford Eye Hospital - UK



References

1. Fechtner RD, Godfrey DG, Budenz D et al.  Prevalence of ocular surface complaints in patients using topical intraocular pressure – lowering medications.  Cornea, 2010; 29 : 618-621.

2. Baudouin C, Renard JP, Nordmann JP et al.  Prevalence and risk factors for ocular surface disease among patients treated over the long term for glaucoma or ocular hypertension.  European J Ophthalmol 2013; 23 ; (1) 47-54.

3. Marcet MM, Shtein RM, Bradley EA et al.  Safety and efficacy of lacrimal drainage system plugs for dry eye syndrome.  Ophthalmology 2015; 122: 1681-1687.

4. Opitz DL, Tung S, Jang US, Park JJ.  Silicone punctal plugs as an adjunctive therapy for open angle glaucoma and ocular hypertension. Clin Exp Optom 2011; 94:4381-442.




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