Association Between Dry Eye-Related Markers and the Rate of Punctal Plug Loss

Purpose: To investigate indicators of dry eye disease that influence punctal plug loss.Methods: A retrospective review was conducted on patients who received SuperFlex<sup>®</sup> punctal plugs. To analyze the relationship between punctal plug loss and markers for dry eye, patients were categorized into a loss group, defined as those who experienced unintended loss within 3 months of insertion, and a retention group. In total, 11 indicators were compared between the two groups, including meibomian gland expressibility, cloudiness of meibomian gland secretions, telangiectasis of the eyelid margin, tear osmolarity, Schirmer’s test value, the expression levels of matrix metalloproteinase-9 in tears, NEI/Industry grading system score, Sjögren’s International Collaborative Clinical Alliance ocular staining score, tear lipid layer thickness (LLT), and meiboscore.Results: In all, 47 eyes of 30 patients were included in the study. Of these, 16 eyes (34%) were assigned to the loss group. Meibomian gland expressibility grade was significantly higher in the loss group (1.60 ± 0.58) compared to the retention group (1.04 ± 0.37, <i>p</i> = 0.0247). Additionally, LLT was significantly lower in the loss group (58.7 ± 17.0 nm vs. 88.4 ± 17.6 nm, <i>p</i> = 0.0303). However, no significant correlations were found between punctal plug loss and other indicators of dry eye.Conclusions: Worse meibomian gland expressibility and thinner LLT are associated with a higher rate of punctal plug loss.