Japanese Journal of Ophthalmology

, Volume 56, Issue 3, pp 208–213 | Cite as

Punctal plugs for treatment of post-LASIK dry eye

  • Yang Hao Yung
  • Ikuko Toda
  • Chikako Sakai
  • Atsushi Yoshida
  • Kazuo Tsubota
Clinical Investigation



To evaluate the efficacy of punctal plugs for patients with post-LASIK dry eye.

Materials and methods

A prospective study was conducted on 25 eyes of 18 patients who underwent LASIK. All eyes fulfilled the Japanese dry-eye criteria and had not responded to conventional treatment with artificial tears by 1 month postsurgery. They were randomly divided into a plug and a non-plug group. Punctal plugs were inserted into the superior and inferior puncta in the plug group after the 1-month examination. Uncorrected and best corrected visual acuity (UCVA, BCVA), refraction, functional visual acuity (FVA) after 10 s eye opening (FVA 10), surface regularity index (SRI) after 10 s eye opening (SRI 10), corneal sensitivity, Schirmer test, fluorescein staining (FS), tear break-up time (TBUT), and symptoms were compared between the groups 1 and 3 months postsurgery. Changes in these data from 1 to 3 months were also compared between the groups.


The values in SRI 10, FS, and TBUT were significantly better in the plug group at 3 months. Changes in the values of UCVA, FVA 10, FS, TBUT, and symptoms between 1 and 3 months improved significantly in the plug group compared with the non-plug group.


Our results suggest that punctal occlusion for both puncta is effective for patients with post-LASIK dry eye that cannot be controlled by artificial tears alone. Punctal plugs can improve not only the symptoms and tear function, but also the quality of vision, for example FVA.


LASIK Dry eye Punctal plugs 


  1. 1.
    Toda I, Asano-Kato N, Komai-Hori Y, Tsubota K. Dry eye after laser in situ keratomileusis. Am J Ophthalmol. 2001;132:1–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Wilson S. Laser in situ keratomileusis-induced (presumed) neurotrophic epitheliopathy. Ophthalmology. 2001;108:1082–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Toda I, Kato-Asano N, Hori-Komai Y, Tsubota K. Laser in situ keratomileusis for patients with dry eye. Arch Ophthalmol. 2002;120:1024–8.PubMedGoogle Scholar
  4. 4.
    Sakamoto A, Kitagawa K, Tatami A. Efficacy and retention rate of two types of silicone punctal plugs in patients with and without Sjögren syndrome. Cornea. 2004;23:249–54.PubMedCrossRefGoogle Scholar
  5. 5.
    Tai MC, Cosar CB, Cohen EJ, Rapuano CJ, Laibson PR. The clinical efficacy of silicone punctal plug therapy. Cornea. 2002;21:135–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Kaido M, Ishida R, Dogru M, Tsubota K. A new punctal plug insertion technique to prevent intracanalicular plug migration. Am J Ophthalmol. 2009;147:178–82.PubMedCrossRefGoogle Scholar
  7. 7.
    Chalita MR, Chavala S, Xu M, Krueger RR. Wavefront analysis in post-LASIK eyes and its correlation with visual symptoms, refraction, and topography. Ophthalmology. 2004;111:447–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Huang B, Mirza A, Qazi MA, Pepose JS. The effect of punctal occulusion on wavefront aberrations in dry eye patients after laser in situ keratomileusis. Am J Ophthalmol. 2004;137:52–61.PubMedCrossRefGoogle Scholar
  9. 9.
    Khalil MB, Latkany RA, Speaker MG, Yu G. Effect of punctal plugs in patients with low refractive errors considering refractive surgery. J Refract Surg. 2007;23:467–71.PubMedGoogle Scholar
  10. 10.
    Shimazaki S. Definition and diagnosis of dry eye 2006. J Eye. 2006;24:181–4.Google Scholar
  11. 11.
    Matsui H, Kumano Y, Zushi I, Yamada T, Matsui T, Nishida T. Corneal sensation after correction of myopia by photorefractive keratectomy and laser in situ keratomileusis. J Cataract Refract Surg. 2001;27:370–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Kanellopoulos Aj, Pallikaris IG, Donnenfeld ED, Detorakis S, Koufala K, Perry HD. Comparison of corneal sensation following photorefractive keratectomy and laser in situ keratomileusis. J Cataract Refract Surg. 1997;23:34–8.PubMedGoogle Scholar
  13. 13.
    Perez-Santonja JJ, Sakla HF, Cardona C, Chipont E, Alio JL. Corneal sensitivity after photorefractive keratectomy and laser in situ keratomileusis for low myopia. Am J Ophthalmol. 1999;127:497–504.PubMedCrossRefGoogle Scholar
  14. 14.
    Freeman JM. The punctum plug: evaluation of a new treatment for the dry eye. Trans Am Acad Ophthalmol Otolarynol. 1975;79:874–9.Google Scholar
  15. 15.
    Tsubota K, Dogru M. Changing perspectives for the treatment of dry eye. COP. 2002;1:1–8.Google Scholar
  16. 16.
    Goto E, Yagi Y, Matsumoto Y, Tsubota K. Impaired functional visual acuity of dry eye patients. Am J Ophthalmol. 2002;133:181–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Toda I, Hori-Komai Y, Asano-Kato N, Tsubota K. Ocular surface treatment before laser in situ keratomileusis for patients with severe dry eye. J Refract Surg. 2004;20:270–5.PubMedGoogle Scholar
  18. 18.
    Sugita J, Yokoi N, Fullwood NJ, Quantock AJ, Takada Y, Nakamura Y, et al. The detection of bacteria and bacterial biofilms in punctal plug holes. Cornea. 2001;20:362–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Nishii M, Yokoi N, Komuro A, Sugita J, Nakamura Y, Kojima K, et al. Comparison of extrusion rate for two different design of punctal plugs. J Jpn Ophthalmol Soc. 2003;107:322–5.Google Scholar
  20. 20.
    Nishii M, Yokoi N, Komuro A, Kinoshita S. Clinical investigation of extrusion of a new punctal plug (Flex Plug®). J Jpn Ophthalmol Soc. 2004;108:139–43.Google Scholar
  21. 21.
    Scheepers M, Pearson A, Michaelides M. Bilateral canaliculitis following SmartPLUG insertion for dry eye syndrome post LASIK surgery. Graefes Arch Clin Exp Ophthalmol. 2007;245:895–7.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2012

Authors and Affiliations

  • Yang Hao Yung
    • 1
  • Ikuko Toda
    • 2
    • 3
  • Chikako Sakai
    • 2
  • Atsushi Yoshida
    • 2
  • Kazuo Tsubota
    • 3
  1. 1.Smile Eye ClinicYokohamaJapan
  2. 2.Minamiaoyama Eye ClinicTokyoJapan
  3. 3.Keio University School of MedicineTokyoJapan

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