Punctal plugs play an important role in the management of dry eye disease, but punctal occlusion is a dramatically underused intervention.
"The treatment recommendations for [DED] issued in 2007 by members of the Management and Therapy Subcommittee of the International Dry Eye WorkShop list punctal plugs as an option for patients with Level 2, moderate-type disease. However, available statistics indicate that only about 12% to 15% of ophthalmologists and optometrists are using this modality," said Dr. Potaznick, associate professor of optometry, Northeastern College of Optometry, Boston.
Evaluation to identify appropriate candidates should include measurement of tear breakup time, tear meniscus, ocular surface staining with both fluorescein and lissamine green, Schirmer's test or phenol red thread test to assess tear production, and a symptom questionnaire. The latter is also particularly helpful for documenting patient response, Dr. Potaznick noted.
"Improvement in patients with [DED] is a slow and gradual process. It is useful to have some metric to prove to patients they are benefiting from intervention," he explained.