Punctal Plugs for Dry Eye

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Tears help to keep your eyes comfortable. When you have dry eyes, your eyes don't make enough tears, or the tears they make are of poor quality. Punctal plugs are a possible treatment for dry eye, especially if other treatments are not effective. The procedure to insert punctal plugs is called punctal occlusion.

Discomfort from dry eyes

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The tear ducts in your eye, also called puncta, are small holes that drain any tears. Tear ducts are located near the inner corner of your upper and lower eyelids.

Punctal plugs, also called tear duct plugs or lacrimal plugs or occluders, are devices placed inside the tear ducts to help block fluid such as tears from leaving the eyes. This can include both your natural tears and any artificial tears that you use.

Normally your tears will drain out of the eye in the area of the back of your nose and then into your throat. With punctal plugs in place, these tears will not drain out.

Punctal plugs can help keep your eyes moist and soothe any discomfort. These tiny devices are about the size of a grain of rice.

Occasionally, eye doctors may use punctal plugs for other eye diseases or after eye surgery. Eye doctors insert punctal plugs fairly quickly and easily through punctal occlusion. Punctal plugs also can be removed if needed.

Types

Tear duct plugs are made of a few different types of materials that determine how long they will last in the eye. Each type of punctal plug has a different purpose.

Semi-Permanent

Semi-permanent punctal plugs are meant to remain in your eyes, although an eye doctor can remove them if needed.

Semi-permanent plugs are made of materials such as acrylic or silicone. Many punctal plugs are placed in the tear duct, but one type of semi-permanent punctal plug is inserted into a part of the tear duct called the canaliculus. This is a deeper part of the tear duct.

Dissolvable

Dissolvable punctal plugs may last up to about a week or up to a couple of months. They have a few uses:

  • After vision-correcting surgery such as LASIK. Your eyes may feel a little drier than usual after vision-correcting surgery, which is why eye doctors may recommend punctal plugs.
  • When you want to test out punctal plugs to see if they help with your dry eyes

Dissolvable punctal plugs are made of material like collagen (which is also found in bone and skin) that will eventually be absorbed by the body.

How Much Do Punctal Plugs Cost?

Punctal plugs can range in price from the low $200s to around $700. Some types of insurance, including Medicare, will cover the cost (or part of the cost) of punctal plugs if medically needed. This means that your eye doctor already has used other options to treat dry eye, such as ointments and prescription medications.

Punctal Occlusion

Punctal occlusion is the name of the procedure used to insert punctal plugs.

Before

Before inserting punctal plugs for dry eye, your eye doctor will perform various tests to confirm the diagnosis of dry eye and to measure the severity of your dry eye. Your eye doctor also may try other treatments to help relieve your dry eye symptoms, including:

  • Artificial tears
  • Eye ointments
  • Prescription eye drop drugs that help your eyes make more tears

There may be reasons these treatments do not work for you, perhaps due to side effects like stinging and burning in the eyes. When these treatments do not work, your eye doctor may recommend the use of punctal plugs. Or you may end up using both prescription eye drops as well as tear duct plugs.

Before the procedure, your eye doctor will likely measure your tear duct opening to determine the size of the plug you'll need. You do not need to do anything to prepare for punctal occlusion.

During

Before punctal occlusion, the eye doctor may or may not insert numbing drops, also called topical anesthetic drops, in the eyes. However, many patients can have punctal occlusion without these drops.

You can have punctal plugs inserted in the tear duct of your lower eyelid, upper eyelid, or both eyelids. The number of plugs used often relates to how severe your dry eye is.

The actual way that a doctor performs punctal occlusion will depend on a few factors:

  • The design of the plug that is used
  • The shape of the plug
  • Whether the plug has special inserters for placement in the eye or not
  • Where the plug will be inserted

Punctal occlusion takes just a couple of minutes. You may feel a little uncomfortable during the insertion process.

After

There is no recovery time after punctal occlusion. You can drive home on your own and carry on with any normal activities. Most people can't feel the plugs in their eyes, or if they can, the feeling is not bothersome.

Will Punctal Plugs Feel Uncomfortable?

You may wonder if having one or more punctal plugs in your eye will feel uncomfortable. Rest assured, most people do not feel them in the eyes. If you do feel them at first, you likely will get used to them.

If you feel them, either initially or at any point during the time they are in your eyes, they should not feel uncomfortable. If they feel irritating, let your eye doctor know. That could indicate a potential problem, such as an infection.

Side Effects and Complications

Although punctal plugs often help to soothe dry eye, there are some potential side effects and complications. They include:

  • You may have a scratchy feeling in the corner of your eye near where the punctal plug is located. This is the most common side effect. Many people get used to this feeling.
  • Your eyes may now have too many tears. If your eyes now feel too watery, let your doctor know. You can strategize another way to manage your eyes and tear control. You may opt to have the tear duct plugs removed.
  • You may experience redness and swelling due to irritation in the tear ducts. If this happens over the long term, it can damage the tear ducts.
  • The punctal plugs may pop out of your eyes. This happens more frequently if you rub your eyes.
  • Although rare, it is possible to develop an infection from punctal plugs.

Should I Still Use Lubricating Drops?

Punctal plugs are one way to lower your use of artificial tears/lubricating drops. You can still use these drops when you have punctal plugs, although you will likely use them less often. If they cause your eyes to feel too watery once you have plugs, you should use them less frequently.

Prognosis

An American Academy of Ophthalmology analysis of 25 studies of the use of punctal plugs for dry eye found that they improved symptoms by greater than or equal to 50% and improved the health of the eye surface. Patients reported less use of artificial tears and had better comfort in wearing contact lenses.

Removing Punctal Plugs

There are a few reasons that punctal plugs would need to be removed. You may find them uncomfortable, or you may develop an infection from them. If they cause too many tears, you may prefer to have them removed.

Let your eye doctor know if your eyes feel scratchy or painful. These symptoms indicate the need for an exam and the potential removal of your punctal plugs.

A surgical instrument called forceps can carefully remove the tear duct plugs from the tear duct. They can also be removed using a saltwater solution that will flush the plugs into the nose or throat. Eye doctors may use surgery to remove punctal plugs located more deeply in the tear duct.

A Word From Verywell

Punctal plugs can provide relief for some people who experience chronic dry eye. The procedure to insert plugs is quick and easy. Although there are side effects and potential complications, most people who use plugs find relief from their dry eye. Talk to your doctor about any pros and cons.

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Article Sources
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