{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T15:57:39Z","timestamp":1790351859663,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2018,5,24]],"date-time":"2018-05-24T00:00:00Z","timestamp":1527120000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001782","name":"University of Melbourne","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001782","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Exper Ophthalmology"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Importance<\/jats:title><jats:p>Ocular surface disease (OSD) is common and can reduce treatment compliance and quality of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>To determine whether a punctal plug improves OSD and reduces intraocular pressure (IOP) in patients using prostaglandin analogue monotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Randomized controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Sixty eligible subjects aged &gt;18\u2009years with symptomatic OSD from glaucoma clinics were invited to participate. Lacrimal or glaucoma surgery, lid malposition and contact lens wear were exclusion criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>One eye received an inferior punctal plug, leaving the fellow eye as a control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Ocular surface disease index (OSDI), tear film breakup time (TF\u2010BUT), Oxford cornea score, tear osmolarity and IOP were compared at baseline and 6 weeks by masked investigators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 60 eligible, 48 (80.0%) participated (mean age 69.6 years; 60.0% female). OSDI reduced following plug insertion (mean difference [MD] 14.5, 95% confidence interval [CI] 5.06\u201323.94, <jats:italic>P<\/jats:italic> &lt; 0.001). Compared to control eyes, in eyes receiving plugs the TF\u2010BUT increased (MD 2.3 s, 95% CI 1.4\u20133.2, <jats:italic>P<\/jats:italic> &lt; 0.001), the Oxford cornea score decreased (MD 0.5, 95% CI 0.3\u20130.7, <jats:italic>P<\/jats:italic> &lt; 0.001), and tear osmolarity decreased (MD 10 mOsm\/L, 95% CI 3.5\u201316.5, <jats:italic>P<\/jats:italic> = 0.003). Punctal plugs resulted in a significantly lowered IOP (MD 1.5 mmHg, 95% CI 0.1\u20132.9, <jats:italic>P<\/jats:italic> = 0.032). Sub\u2010group analyses showed similar efficacy regardless of prostaglandin preservative status or lubricant drop use. Plugs were well tolerated but extrusion occurred in 8.5%, and epiphora increased in 6.5% eyes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Punctal plug insertion improves subjective and objective measures of OSD and results in a reduced IOP in patients with symptomatic ocular surface disease using prostaglandin analogue monotherapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ceo.13311","type":"journal-article","created":{"date-parts":[[2018,4,27]],"date-time":"2018-04-27T03:46:36Z","timestamp":1524800796000},"page":"888-894","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Effect of a punctal plug on ocular surface disease in patients using topical prostaglandin analogues: a randomized controlled trial"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9134-1932","authenticated-orcid":false,"given":"Justin C","family":"Sherwin","sequence":"first","affiliation":[{"name":"Oxford Eye Hospital, John Radcliffe Hospital  Oxford UK"},{"name":"Ophthalmology, University of Melbourne Department of Surgery  Melbourne Australia"},{"name":"Centre for Eye Research Australia Royal Victorian Eye and Ear Hospital  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gokulan","family":"Ratnarajan","sequence":"additional","affiliation":[{"name":"The Queen Victoria Hospital  East Grinstead UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babar","family":"Elahi","sequence":"additional","affiliation":[{"name":"Dudley Hospital NHS Trust  Dudley UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Bilkiewicz\u2010Pawelec","sequence":"additional","affiliation":[{"name":"Oxford Eye Hospital, John Radcliffe Hospital  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F","family":"Salmon","sequence":"additional","affiliation":[{"name":"Oxford Eye Hospital, John Radcliffe Hospital  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,5,24]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"National Institute for Health and Clinical Excellence. 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