Punctal plugs are small, biocompatible devices inserted into tear ducts to block drain. This increases the eye’s tear movie and surface moisture to eliminate dry eyes. Likewise known as punctum plugs, lacrimal plugs or occluders, these devices often are no larger than a grain of rice.
Punctal plugs normally are considered when non-prescription or prescription eye drops fail to ease your dry eye condition.
Punctal Plugs For Dry Eyes
Two basic types of tear duct plugs are:
- Semi-permanent, usually made from long-lasting materials such as silicone.
- Dissolvable, made from materials such as collagen that the body ultimately soaks up.
Temporary or dissolvable punctal plugs usually last from a couple of days to as long as several months. These types of plugs would be used in circumstances such as preventing dry eyes after LASIK, if you opt to have refractive surgery.
Dissolvable, temporary punctal plugs often are used to figure out if the treatment works for your dry eye condition. If so, then semi-permanent punctal plugs may be considered.
How Are Punctal Plugs Inserted in Tear Ducts?
Depending upon the kind of punctal plug picked, your optometrist first may use an unique instrument to determine the size of your tear duct openings (puncta). This helps figure out the proper size of the punctal plug needed to block drain within the channel and to keep it securely in place.
Lots of eye doctors require only a lighted, close-up assessment of your eye to identify the size and type of punctal plug you require. In many cases, a one-size-fits-all style of punctal plug may be used.
To prepare you for the procedure, some optometrist use a local anesthetic prior to inserting the punctal plug. In most cases, no anesthetic is needed.
Each eyelid has one punctum, located at its inner margin near the nose. Punctal plugs can be inserted in the puncta of the lower covers, the upper covers or both. An instrument may be used to dilate the tear duct opening for much easier insertion.
See also: Hard-to-fit Contact Lenses
Many punctal plugs are prepackaged with disposable devices that assist your optometrist insert the plug.
Inserters are offered in various designs, such as a forceps design that is squeezed to press the plug into place. Narrow, syringe-style inserters likewise can be used. Your optometrist might use other instruments such as forceps to assist put the punctal plug in your eye’s tear duct.
Some punctal plugs are inserted just into the puncta so they still can be seen and mechanically eliminated if essential.
Other punctal plugs are inserted deeper into the canaliculus, where they are out of sight. These types of tear duct plugs — technically called intracanalicular plugs — do not protrude from the punctum. They are not seen or felt, and automatically comply with the shape of the cavity.
In the unusual case where removal is required, intracanalicular plugs are extracted by flushing them out.
Aside from small initial pain, you should not feel the punctal plug once it is in place. Right away after the procedure, you need to have the ability to drive yourself home and resume normal activities.
Types of Punctal Plugs
Punctal plugs have lots of styles and shapes, consisting of:
- Umbrella. These types do not “disappear” into the tear duct, making them simple to spot and get rid of if necessary.
- Tapered. This design exerts additional force horizontally to assist keep the punctal plug in its correct place.
- Hollow. A hollowed interior can help the punctal plug comply with the shape of the eye’s tear duct.
- Tank. This design captures and holds tears, which helps reduce foreign body sensation and increase convenience.
- Slanted or low profile cap. This design can assist preserve comfort, while offering extra stability.
Materials used to make punctal plugs consist of silicone, collagen, hydrophobic acrylic polymer, polydiaxonone and hydrogel. Some punctal plugs are coated with a “slick” surface for much easier insertion.
Soft, flexible punctal plugs made from these typical products can increase convenience and help the devices conform more easily to the shape of the tear drain channels.
Two types of soft intracanalicular plugs currently exist. One type, made of an acrylic product, is solid at room temperature however melts on contact with temperature. An example is the SmartPlug (Medennium), which rests in the drainage channel in a semisolid state just like gelatin.
Another type of soft intracanalicular plug is made of hydrogel material that, once it is inserted into the lacrimal punctum, hydrates until it entirely fills the cavity. Type Fit (Oasis Medical) is an example of this kind of punctal plug.
Older people especially can take advantage of soft punctal plugs because — with aging — orifices such as tear drainage channels expand and muscular lining becomes less elastic. In this case, softer punctal plugs are more likely to remain in location than harder ones.
Punctal Plugs Side Effects and Problems
Generally, punctal plug insertion is uneventful and rarely involves severe side effects or problems.
Excessive tearing (epiphora) and watery eyes can happen when the punctal plug does its job too well. In this case, you might need to visit your eye doctor for removal of the plug or replacement with a various type to better control the amount of tears on your eye.
Displacement or loss of the plug is common and can occur for many reasons, such as when individuals rub their eyes and mistakenly dislodge the device. Hard types of punctal plugs in particular are most likely to end up being dislodged and fall out. Once again, you will have to visit your eye doctor to receive a replacement punctal plug.
Eye infections may take place, though rarely, in association with the devices. Canaliculitis results from an uncommon reaction to punctal plugs, with symptoms such as swelling and yellow-colored secretions from the tear duct. Such infections may result from upper respiratory infections where blowing the nose under pressure may require bacteria from the nasal cavity backward into the canaliculus.
In these cases, you might require treatment with topical antibiotics, oral antibiotics and/or elimination of the punctum plug.
Also read: Dry Eye Syndrome Treatment
Other uncommon complications can occur when the plug all of a sudden moves outside the target area and deeper into the eye’s drainage channels. This can create obstructions causing conditions such as dacryocystitis, with swelling, pain and pain.
Soft types of punctum plugs usually can be eliminated by flushing them out (irrigation). However, surgery might be required when a difficult kind of punctum plug moves into the eye drain canal. Since of the nail-shape head of current hard plugs, nevertheless, entrapment within the tear drain canal is uncommon.
With rigid types of punctum plugs, some extra tissue development may take place as a reaction and cause the channel to narrow (stenosis). If required, your eye doctor can simply remove the punctal plug. However, the punctal plug’s purpose is to slow the exit of tears, so additional tissue can be advantageous because it assists attain that goal.
When Should Punctal Plugs Be Removed?
While semi-permanent punctal plugs can last forever, they likewise are easily eliminated.
If elimination is thought about necessary, your eye doctor might use forceps to grasp and extract the plug. Another technique of removal includes flushing with a saline option, which forces the punctal plug to leave into the nose or throat where tear ducts drain.