Punctal plugs are a treatment option for patients with dry eyes. They are small devices placed in our tear ducts in our eyes called puncta, which drain our tears. Each eye has one of these drainage ducts at the bottom and one at the top.

How does dry eye occur?

Dry eyes occur when the front surface of your eye is improperly lubricated either due to inadequate tear production or due to a problem with the outermost layer of our tears, which causes your tears to evaporate much more quickly, resulting in the front part of the eye not remaining as moist.

What are punctal plugs?

A punctal plug is a device that is placed inside a tear duct to prevent tears from draining, allowing the tears to stay on the surface of the eye, keeping it moist and lubricated in an attempt to reduce dry eye symptoms. Punctal plugs are also sometimes referred to as punctum plugs, lacrimal plugs or occluders

What are the different types of punctal plugs?

There are different types of punctal plugs.

• Temporary and dissolvable punctal plugs - Dr. Pinkhasov usually prescribes temporary and dissolvable plugs. They are made from collagen and naturally dissolve on their own. Typically the ones that are most commonly used, they dissolve within three months. It's a great option for patients who just want to test the waters and see if punctal plugs are right for them without having to commit long-term. If your eye doctor deems that it is most appropriate for you, then you will come back every three months to get a fresh new set of punctal plugs inserted.
• Semi permanent punctal plugs - There are also semi-permanent plugs, which last longer. They are made of medical plastic.It is advisable to change these plugs every year just because they are more hygienic for your eyes.

How are punctal plugs inserted?

Punctal plugs are typically inserted by injecting an anaesthetic into your eyes. Our eye doctor will then select an appropriate size plug, depending on the size of your puncta, to be placed into your puncta, and forceps will be used to insert the plug into your tear ducts. They are placed on the bottom two tear ducts. The procedure usually takes a few minutes, and there is no discomfort involved. After the procedure, you can resume your normal activities.

Do punctal plugs provide relief?

If you've been using artificial tears and warm compresses without really seeing results from them, punctal plugs may be the best option for you. When you use punctal plugs, you usually feel relief right away. Your eyes feel more lubricated and moist, and you require less artificial tears throughout the day.

Do punctal plugs cause any side effects?

There may be, however, some side effects associated with punctal plugs.

• You may feel some irritation on the inner corners of your eyes.
• If the plugs are not fit correctly, it protrudes and irritates the inner corners of the eye. In rare cases, you may experience inflammation or infection.
• In rare cases the plugs may fall out when rubbing your eyes
• You may experience excessive tearing or eye watering
• Although extremely uncommon, there are some reports of eye infections after using punctal plugs

You should visit our eye doctor if you're experiencing any of these symptoms so that we can either remove the plug or treat any symptoms you may be experiencing.

Are punctal plugs recommended for everyone?

As great as punctal plugs are, they're not suitable for everyone.

One of the key things about dry eye is to try and stabilize the tear film, then progress to treat the underlying cause. This is why no one treatment is the ideal solution for every patient. While punctal plugs are generally considered a great solution that addresses the symptoms quickly with a strong safety profile. We wouldn't want to leave the underlying cause of the symptoms such as allergic conjunctivitis, meibomian gland dysfunction, or severe blepharitis, to remain, so it is important to treat those conditions before treating your symptoms of dry eyes. In the case of an active eye infection, it's important to treat that first before proceeding with punctal plugs.

Are punctal plugs better than eye drops?

Punctal plugs are generally a better idea than eye drops as they don't change the natural balance of your tear film. Our tear film is made up of an aqueous, mucine, and lipid layer; overuse of eye drops can change our tear film's makeup which can make dry eye symptoms worse.

Furthermore our tears have naturally occuring antioxidants and organic compounds that are complex, overuse of eye drops or artificial tears can change the composition of tear film in a way that exacerbates symptoms.

Using artificial tears that include preservatives has been shown to reduce wound healing on the cornea. Preservatives are used in multi-dose units in order to prevent microbial growth within the bottle and increase their shelf life.