Punctal plugs are microscopic blockers that are inserted into the tiny openings in the inner eyelids known as punctae, where the tears drain. These can be helpful for patients who suffer from dry eye symptoms due to reduced quanity of tears and which eye drops alone cannot relieve. In order to understand how punctal plugs work to alleviate the symptoms of dry eye, it’s helpful to know a little about the anatomy of the eye.
Natural tears in the eye are produced by the lacrimal gland under the upper outer part of the eyelid, and drain through the punctae (tiny openings) within the lower eyelids into the nasolacrimal duct, which is a tube that connects the eye, nose and throat.
Dry eye can be caused by many underlying factors. When the symptoms are caused by a decrease in the tear production, punctal plugs are often a solution. When the eye has a lack of tears there are three ways to treat this: Use natural tear drops to supplement this, use restasis, or the most effective is to insert punctal plugs These plugs act much like a stopper in the drain of a sink. By keeping the tears from draining out of the eye, punctal plugs keep the tears on the surface of the eye longer to maintain more consistent lubrication of the eye.
There are 2 puncta (openings) in the inner corners of the eyelids of each eye. There’s one in the inner corner of the upper eyelid and one in the inner corner of the lower eyelid. The upper puncta is typically smaller than the lower puncta. The size of these openings also varies between patients. This is why punctal plugs come in a variety of sizes, shapes and materials. Your ophthalmologist will examine your eyes under a special slit-lamp microscope to determine the proper size and recommend the type of plug best suited for you.
Some of the most widely used punctal plugs fall into two categories:
Collagen: These plugs are temporary, absorbable plugs. The duration of these plugs vary and can last anywhere from 2 weeks to 3 months. This type of plug is inserted using forceps and is buried in the puncta.
Silicone: These plugs are permanent and usually come pre-loaded in a pen-like device, which is used to insert the plug. These plugs are shaped like an umbrella with the umbrella portion sitting right on top of the puncta. Silicone plugs range in size from .4mm to .9mm.
Side effects of punctal plugs are rare, but can include:
Excessive tearing (epiphora): This happens when punctal plugs are a bit too effective. The tears can collect in the inner corner of the eye and spill over onto the cheeks. For most patients, this is temporary and will subside within a few days of insertion. These symptoms are seen more often with silicone plugs.
Foreign body sensation: Occasionally, patients complain that they can feel the punctal plugs, particularly when they blink. Usually this fades over days. If it persists, the plug can be repositioned or removed.
Infection: As the plugs come pre-packaged in sterile containers, this is extremely rare. However, if the puncta does become infected, it can be treated with antibiotic eye drops or pills. The plug may also be removed.
Once inserted, the plugs are invisible to the naked eye. Insertion of punctal plugs is a relatively painless procedure that is done in the office with the assistance of a slit-lamp microscope, which illuminates and magnifies the tiny punctal openings. The total time it takes to insert these plugs is less than 5 minutes. When used to treat the symptoms of dry eye, particularly when eye drops have failed, punctal plugs are usually covered by insurance companies. Ask your eye doctor today if punctal plugs are a viable option for you!
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