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Five Misconceptions Related to Punctal Plugs in Dry Eye Management

Song, Jong Suk, MD, PhD; Woo, In Ho, MD; Eom, Youngsub, MD, PhD; Kim, Hyo Myung, MD, PhD

doi: 10.1097/ICO.0000000000001734

Abstract: Punctal plugs are an effective treatment option for patients with aqueous-deficient dry eye refractory to topical medications. However, punctal plugs are not commonly used in clinical practice mainly because of various misconceptions, rather than clinical complications. We analyzed previous studies and present 5 misconceptions related to punctal plugs. The first and most important misconception is that ocular surface inflammation should be sufficiently controlled before punctal plug insertion. However, it is unclear how ocular surface inflammation can be sufficiently controlled in patients refractory to conventional topical medications. The second misconception is that silicone punctal plugs are made of nonabsorbable materials and, therefore, permanent. In fact, silicone plugs are reversible and can be easily removed if necessary. Therefore, depending on the specific type, nonabsorbable plugs may be classified as reversible or permanent. The third misconception is that punctal plugs disrupt normal tear drainage. However, punctal plugs maintain natural tears on the ocular surface for extended periods and reduce the frequency of artificial tear use. The fourth is that all punctal and canalicular plugs have similar effects. The efficacy and complication rates differ depending on plug types. The fifth misconception about punctal plugs is that they are effective only in aqueous-deficient dry eye disease. Many studies have reported that plugs are effective in a variety of ocular diseases and conditions. Understanding these 5 misconceptions may provide an opportunity to rethink the use of silicone punctal plugs in clinical practice.

Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.

Correspondence: Jong Suk Song, MD, PhD, Department of Ophthalmology, Guro Hospital, Korea University College of Medicine, 148 Guro-dongro, Guro-gu, Seoul 152-703, South Korea (e-mail:

Supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03028552).

The authors have no conflicts of interest to disclose.

Received June 29, 2018

Accepted July 03, 2018

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