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    How punctal plugs may influence tear osmolarity and aid in dry eye therapies

    By retaining tears on ocular surface, punctual plugs may alleviate dry eye disease


    Patients were evaluated at four time points—baseline, 30 days, 60 days, and 90 days after the start of the study—and were randomly assigned to one of two treatment groups:

    • group A, in which punctal plugs were inserted during the second evaluation in 12 subjects; and

    • group B, in which sham treatment was administered during the second visit and punctal plugs were inserted during the third evaluation in 16 subjects.

    Dr. Pepose reported no difference in the baseline tear osmolarity, symptoms, or other dry eye signs between the two groups.

    At visit 3, the patients with punctal plugs (group A) had a mean reduction in osmolarity from baseline of –8.5 ± 16.42 mOsm/L including four of 12 subjects with reduction in osmolarity of more than 10 mOsm/L (mean, –21.75 ± 13.22 mOsm/L).

    In group B, no decrease in tear osmolarity was seen during sham treatment. However, following punctal plug insertion, nine of 16 subjects had a decrease of over 10 mOsm/L (mean, –21.89 ± 11.29 mOsm/L).

    At visit 4, no clinically relevant changes were seen in the other parameters measured between the two treatment groups.

    Following punctal plug treatment, 13 of 28 subjects had a reduction in osmolarity of over 10 mOsm/L, four patients in group A and nine patients in group B. Eight of the total 56 eyes had a reduction in corneal staining by one grade, five eyes in group A and three eyes in group B. Six of eight eyes that had reduced staining also had reduced osmolarity by 10 mOsm/L, according to Dr. Pepose.

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