Study: What works best... plugs or Restasis or both?

Well, I'm glad we're seeing more comparative studies and I hope they continue. I also hope we see something soon with longer-term follow-up. I will put a new subscription to Cornea on my Christmas wishlist so I can learn more about the methods and drop-out rates used in studies like this.

I've probably missed some along the way but this is the first thing I recall seeing that specifically supports the use of plugs plus Restasis.

Comparison of topical cyclosporine, punctal occlusion, and a combination for the treatment of dry eye.
Cornea. 2007 Aug;26(7):805-9
Roberts CW, Carniglia PE, Brazzo BG

In brief...

They both help, individually.
Together, they do better than either treatment individually.


ABSTRACT - from which I had to leave some parts out because this stupid blog software thinks that the >'s are HTML rather than "greater than" signs, grrr. If anybody knows how to get the blog to ignore it please let me know.

PURPOSE:: To compare the efficacy of topical cyclosporine, punctal occlusion, and a combination for the treatment of dry eye. METHODS:: Patients with dry eye (N = 30) seen in a university-affiliated private practice were randomized to 1 of 3 treatments: cyclosporine 0.05% ophthalmic emulsion (RESTASIS) twice daily, lower-lid punctal plugs (PARASOL), or a plugs-cyclosporine combination. Tear volume, ocular surface staining, and artificial tear use were assessed at baseline and 1, 3, and 6 months. RESULTS:: All treatments improved Schirmer scores by 6 months..., with plug-containing regimens favored at 1 and 3 months (P < 0.001 vs. cyclosporine alone). Cyclosporine-containing regimens, but not plugs alone, improved rose bengal staining at 3 and 6 months.... Artificial tear use decreased with plug-containing regimens at 1 month and with all treatments at 3 and 6 months.... Combination therapy produced the greatest overall improvements and was superior to plugs alone in decreasing artificial tear use at 6 months.... CONCLUSIONS:: All 3 regimens effectively treated dry eye. Plug-containing regimens increased wetness initially; cyclosporine appeared to promote long-term ocular surface health. The effects may be additive. Patients with punctal occlusion may benefit from adjunctive cyclosporine.