Punctal Plugs for Dry Eyes – What You Need To Know

Do you have dry eyes? Has your eye doctor recommended punctal plugs as a treatment? If so, you might be wondering how they work and if they are safe.

In this video, Dr. Hardeep Kataria discusses what you need to know about getting punctal plugs for dry eye disease.

If you don’t like the video or want more information, continue reading.

What is dry eye?

Dry eye disease occurs on the front of the eye, otherwise known as the ocular surface. Many factors can cause or exacerbate dry eyes such as environment, age, hormones, medications, contact lens wear, systemic conditions and ocular surgery.

Symptoms of dry eyes include irritation, itchiness, burning, excess tearing, or blurred vision among others. One of the many treatment options for dry eye includes punctal plugs.

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How do punctal plugs work

Punctal plugs work to minimize drainage of tears from the front of the eye. When you have dry eyes, a counterintuitive process known as “reflex tearing” may occur. The eye sends signals to the brain which produces a compensatory, excess amount of tears which often may run down your face. You may think this is a good sign for dry eyes, but unfortunately, these tears are not the correct composition and can often worsen your condition. 

Punctal plugs are small devices, the size of a grain of rice. They fit the height of your tear duct to block drainage of tears from your eyes. They can be placed in the upper and lower tear ducts. They are available in different sizes and replacement modalities, which will be determined by your eye doctor. 

Types of punctal plugs

Your doctor will recommend the type of plug needed for your eyes. Here are their primary options.

Collagen plugs

Collagen plugs are temporary punctal plugs that last about 2 weeks to 3 months. They typically dissolve on their own. 

Silicone plugs

Silicone plugs are permanent punctal plugs which do not dissolve.

Intra-canalicular plugs

Intra-canalicular plugs are permanent plugs placed deeper into the tear duct and cannot be seen with the naked eye.

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How are punctal plugs inserted?

Punctal plugs are inserted by your doctor in the office. The tear duct is very small and needs to be visualized under the microscope for magnification. An anesthetic eye drop is instilled into the eye to maximize comfort. The doctor will use a pair of forceps (tweezers) to insert the punctal plugs. The procedure usually takes less than a minute and is painless.

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How are punctal plugs removed?

If the punctal plugs need to be removed, your eye doctor will perform this in-office. They may need to be flushed out with saline solution or simply pulled out with forceps. These are painless removal techniques.

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Are there any risks?

Yes. Although uncommon, infections can occur a few days after placement of the punctal plugs. Symptoms include redness, irritation and discharge, especially in the corner of your eye. Eye drops can usually resolve the infection and your eye doctor will remove the punctal plugs. 

Sometimes, the punctal plugs can fall out if the size is too small. Your eye doctor will simply fit you with a larger size.

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Final thoughts

Punctal plugs are often adjunctive therapy in dry eye treatment that eye care professionals use all the time. If you suffer from dry eyes and eye drops have not been helping, ask your eye doctor about punctal plugs!

What are your thoughts on punctual plugs for dry eyes? Share them in the comments below!