What Are Punctal Plugs?
Punctal plugs are very small medical devices that are placed the tear ducts of the eyelids to help slow tears draining away, which in turn helps to keep the eyes moist.
When Are Plugs Recommended?
We typically recommend punctal plugs for patients with dry eye that has not responded to more conservative treatments, including warm compresses, artificial tears, omega 3 supplement, Restasis, or Xiidra. Patients are typically complaining of symptoms, including:
- constantly itchy and dry eyes
- burning eyes
- blurry vision
- eyes that are quick to tire
- light sensitivity
People with chronic dry eye do not produce enough tears and the tears they do make are low quality and they evaporate more quickly than normal. This can cause the eyes to feel dry throughout the day, which then stimulates the body to produce more tears.
These tears are often very watery and do not hydrate the eye well, but the constant signal to the body to create more tears leads to continuous tearing from the eyes throughout the day (this constant tearing sometimes confuses patients into believing that they do not have dry eyes).
How do they work?
Punctal plugs work much like the drain stopper in a bathtub. They are small plugs that sit in the tear ducts of the eyelids.
They work by blocking the tear drainage channel that drains the liquid from the surface of the eye. Instead of escaping, the fluid will stay on the surface of the eye which maintains lubrication throughout the day.
These plugs work with both natural and artificial tears and may reduce the need for eye drops.
There are various types of punctal plugs available, but the punctal occlusion procedure is the same for all of them.
Before the procedure
We will perform an eye examination before inserting punctal plugs. We will ask about your symptoms and any relevant medical history you may have.
We may also inspect your eyes for signs of dryness and check the tears that the eye is producing. This is important, as plugs will not work for everyone.
After diagnosing dry eye, we will usually recommend artificial tears or other treatments to see how the eyes react. If these are not effective after a set amount of time, we may consider using punctal plugs.
If we believes that plugs are the right choice, we’ll examine your punctum (tear duct openings) to choose appropriately sized plugs. There are 4 punctum, but we’ll typically put plugs in the two lower punctum.
Inserting the plug
The process is quite simple and performed in the office at the slit lamp.
A doctor will first numb the tear duct to prevent irritation. They will then insert the plug directly into the tear duct using small forceps or a special plug inserter. If the duct is too narrow, they may need to use an instrument called a lacrimal dilator to open it so the plug will fit.
The entire process is typically over within a few minutes. Some people may experience slight discomfort during the insertion, but the plugs are not usually painful. Once the process is over, most people cannot feel them. With aggressive eye rubbing, the plugs can fall out and be lost forever.
What Are The Risks?
Punctal plugs can rarely cause irritation or an infection. In such cases, the plugs are removed and antibiotic drops are used for a short period of time.