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S.S. Sandhu, T. Ressiniotis, L. Gnanaraj, F.C. Figueiredo; Efficacy of Silicone Punctal Plugs in the Management of Ocular Surface Disease . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3739.
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Purpose: Silicone punctal plugs are now widely used to effect reversible occlusion of the lacrimal drainage system. This helps to conserve naturally produced tears, prolong the contact time of artificial tears and thus reduce ocular discomfort in patients with dry eyes and ocular surface disease. The objective of this study was to analyse the efficacy and complications of the plugs, especially to ascertain the rate of spontaneous plug loss and the factors that affect its retention. Methods: The data was collected retrospectively from the records of 87 consecutive patients who had silicone punctal plug inserted between January 1st 2001 and 31st October 2001. This period ensured at least 12 months of follow up. Results: There were 87 patients with a mean age of 60.9 years (range 28-87 years) of which 58 (66.6%) were females. Fifty-eight (66.6%) patients had a diagnosis of lipid/aqueous tear deficiency. Initially 147 plugs were inserted of which 141 (95.9%) were in the lower punctae. The main indication was discomfort (70.5%). The commonest size used was 0.7mm (43.9%). At three months 106 (72.1%) plugs had been retained and at six months there were 81 (55.1%) plugs in. Thirty plugs stayed in throughout the period. By the end of the study period a total 328 plugs were used. There were 151 (46%) complications, which include plug loss (82.1%), irritability (8.6%), epiphora (4.6%), dislocation (3.3%) and conjunctival injection (1.4%). Twenty-one patients (24.1%) experienced 3 or more losses. The total plug loss was 37.8% and the patients were unaware of loss on 64 (51.6%) occasions. Sixty-six (79.5%) patients reported their symptoms were better at last review. Thirty-seven of these (56.1%) still had plugs in. Conclusions: Symptomatic relief and improvement in ocular surface can be achieved with the usage of punctal plugs, however they are associated with complications. This review highlights the importance of close monitoring of patients with punctal plugs as at six months 45% lost their initial plug and half of them were unaware of the loss. These results suggest that permanent occlusion of the punctae should be considered in patients who need long-term symptomatic relief in the management of ocular surface disease.
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