Abstract
Numerous designs of punctal and canalicular plugs are available on the market. This variety presents challenges to ophthalmologists when choosing punctal plugs for the management of various ocular conditions. The aim of this literature review is to provide a classification system for lacrimal occlusive devices based on their location and duration of action as well as to identify different characteristics of each one of them. We want to give a comprehensive overview on punctal and canalicular plugs including their manufacturing companies, indications, and complications that have been reported in various articles. PubMed and Google Scholar were used to identify articles written in English as well as few articles written in Japanese, Chinese, Slovak, and Spanish that had abstracts in English. Nine different companies that manufacture punctal and canalicular plugs were identified and their plugs were included in this review. Punctal and canalicular plugs are used in the management of various ocular conditions including dry eye disease and punctal stenosis as well as in ocular drug delivery. Although they are a relatively safe option, associated complications have been reported in the literature such as infection, allergic reaction, extrusion, and migration.
Highlights
Dry eye is a condition commonly seen by eye care practitioners; as many as 25% of patients seen in clinic have symptoms of dry eye [1]
The Dry Eye Workshop (DEWS) classified dry eye disease into four levels depending on severity of the disease and treatment options were recommended [7]
Another study evaluated canalicular occlusion with collagen and silicone plugs (Herrick plugs) in patients with dry eye related conjunctivitis. It was a prospective, randomized trial and at the 8-week visit, there was a marked reduction in total dry eye (94.2%) and conjunctival symptom scores (93%) which was in sharp contrast to the sham group that experienced no change from the baseline [34]
Summary
Dry eye is a condition commonly seen by eye care practitioners; as many as 25% of patients seen in clinic have symptoms of dry eye [1]. Lacrimal occlusion with plugs prolongs the effects of lubricants and preserves natural tears. They are relatively contraindicated in patients with dry eyes and coexisting inflammation. This can be utilized in the treatment of glaucoma by increasing the drug retention time [9] Both punctal and canalicular plugs have been associated with complications that have been reported in the literature. Choosing the best suitable punctal/canalicular plug for treatment of various ocular surface disorders (dry eye disease, punctal stenosis, epithelial erosions, and ocular drug delivery) may be difficult for clinicians as a large variety of punctal and canalicular plugs in different shapes, designs, and materials are available. This paper provides a comprehensive overview of all the available punctal and canalicular plugs and can serve as a guide for clinicians to choose the most suitable lacrimal plug when treating the above-mentioned conditions
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