Efficacy of Punctal Occlusion Techniques in Tear Drainage Disorders: A Systematic Review and Meta-Analysis.

Introduction: Tear drainage dysfunction, presenting as epiphora or dry eye symptoms, significantly affects quality of life. Punctal occlusion, using temporary or permanent techniques, aims to retain tears and improve ocular surface health. However, the overall efficacy and safety of these techniques remain variably reported across studies. Methods: This systematic review and meta-analysis followed PRISMA 2020 guidelines and was registered on PROSPERO (CRD42024607753). A comprehensive search of PubMed, MedLine, ScienceDirect, and the Cochrane Library yielded 1550 studies. After screening and eligibility assessment, 14 studies were included. Data extraction covered study design, plug type, follow-up duration, and clinical outcomes. Meta-analyses were performed using Review Manager 5.4. Results: Fourteen studies involving 1537 patients (1155 eyes) were analyzed. Punctal occlusion techniques included silicone, collagen, SmartPlugs, and thermal cautery. Meta-analysis revealed no significant improvements in tear film break-up time (WMD = 0.37; 95% CI: -0.94 to 1.67; p = 0.58), Schirmer scores (WMD = 0.61; 95% CI: -0.96 to 2.18; p = 0.45), or fluorescein staining (WMD = -0.38; 95% CI: -0.92 to 0.16; p = 0.17) compared to controls. However, within group analysis based on follow up period of Schirmer test demonstrated significant improvement (p= 0.01). Reported adverse events were minor and self-limiting. Conclusion: Punctal occlusion techniques offer consistent ocular surface benefits with minimal risks. While current evidence highlights positive clinical outcomes, high-quality randomized controlled trials with standardized metrics are necessary to establish definitive efficacy.