A recent study published in Frontiers in Medicine has reported that combining topical 0.05% cyclosporine A (CsA) with absorbable punctal plugs provides significantly greater improvements in both clinical signs and patient-reported symptoms of Sjögren’s syndrome-associated dry eye (SS-DE) compared with CsA monotherapy.
Sjögren’s syndrome is a chronic autoimmune disorder characterized by lymphocytic infiltration of exocrine glands, leading to reduced tear and saliva production. Dry eye disease is one of its most common and debilitating manifestations, often causing ocular discomfort, visual disturbances, and impaired quality of life. Although topical cyclosporine A is a widely used immunomodulatory treatment that reduces ocular surface inflammation and improves tear production, its therapeutic effect is frequently delayed and may be limited by rapid tear drainage through the nasolacrimal system.
Absorbable punctal plugs have emerged as a noninvasive and biocompatible strategy for temporary punctal occlusion. By reducing tear drainage, these devices enhance tear retention and prolong the contact time of topical medications on the ocular surface. Unlike permanent punctal plugs, absorbable plugs gradually dissolve over time, eliminating the need for removal and minimizing the risk of long-term complications.
To evaluate the potential benefits of this combination approach, researchers conducted a prospective, randomized, observer-masked, paired-eye clinical trial involving 21 patients (42 eyes) with SS-DE. In each participant, one eye was treated with 0.05% CsA in combination with an absorbable lower punctal plug, while the fellow eye received CsA monotherapy. Clinical assessments were performed at baseline and after three months of treatment. Outcome measures included the Ocular Surface Disease Index (OSDI), visual analog scale (VAS) symptom scores, noninvasive tear breakup time (NIBUT), tear meniscus height (TMH), and corneal dendritic cell (DC) density assessed using in vivo confocal microscopy.
After three months, both treatment groups demonstrated significant improvements in all evaluated parameters compared with baseline (p < 0.01). However, eyes receiving combination therapy achieved significantly greater improvements in tear film stability, tear volume, ocular surface inflammation, and symptom relief. Specifically, the combination group showed superior gains in NIBUT (p < 0.01), TMH (p < 0.05), and reductions in corneal DC density (p < 0.01), indicating enhanced control of ocular surface inflammation. Patient-reported symptom improvement, as measured by VAS scores, was also significantly greater in the combination therapy group (p < 0.01).
The investigators further observed a significant positive correlation between changes in VAS and OSDI scores in the combination group (r = 0.528, p = 0.014), suggesting that improvements in objective ocular surface parameters were accompanied by meaningful symptom relief. No such correlation was observed in the CsA monotherapy group (r = −0.172, p = 0.456).
The findings suggest that absorbable punctal plugs can serve as an effective adjunct to topical cyclosporine therapy by enhancing tear retention and prolonging drug exposure on the ocular surface. This dual mechanism may improve both the anti-inflammatory efficacy of CsA and overall patient comfort, addressing key challenges in the management of autoimmune-related dry eye disease.
The authors concluded that the combination of 0.05% CsA and absorbable punctal plugs represents a promising therapeutic strategy for patients with Sjögren’s syndrome-associated dry eye. However, they emphasized the need for larger studies with extended follow-up periods beyond the absorption timeframe of the plugs to determine the long-term durability of treatment benefits and their impact on disease progression.
As the burden of Sjögren’s syndrome-associated dry eye continues to grow, these findings provide encouraging evidence that combining pharmacological therapy with tear-conservation strategies may offer more effective and sustained symptom control than conventional treatment alone.
Reference
Dong Y, Cao JF, Li ZC, Yang XY, Chen L. Enhanced efficacy of 0.05% cyclosporine a combined with absorbable punctal plugs in Sjögren’s syndrome-associated dry eye: a paired-eye clinical trial. Front Med (Lausanne). 2026 Jan 6;12:1674647.