What are punctal plugs? An ophthalmologist explains all

What Are They?

A punctal plug, also known as a punctal occlusion, is a tiny device that is placed inside the tear duct to block it up to prevent tears from draining away.

Punctal plugs may be offered when other forms of treatment for dry eye disease have not been effective or for people with severe dry eye disease to use in conjunction with other treatments.

Why Are They Used?

An ophthalmologist may recommend punctal plugs for people that suffer with dry eye disease. People with dry eye disease suffer from various symptoms such as dry eye sensation, burning or stinging eyes, blurry vision and tired feeling eyes. Dry eye disease is caused by many different reasons from underlying medical conditions and certain medications to the environment we live in, but the main issue is that the eye doesn’t produce enough good quality tears that evaporate quickly from the eye. The body responds by making more ‘emergency tears’ but these tend to be very watery and do not lubricate the eye well and often just run off the eye causing watery eyes. The eye is then unable to keep enough moisture that is needed to keep the eye lubricated and healthy.

How Do They Work?

We have one lower and one upper tear duct in each eye and any or all 4 can be blocked up, depending on what the eye doctor recommends. A punctal plug is inserted into the tear duct which blocks it off. This then prevents tears from being drained away and the tears are forced to stay on the surface of the eye giving it more lubrication. The tears will evaporate throughout the day, as in a healthy eye, but as the eye shouldn’t be making as much ‘emergency tears’ the quality of the tear should be less watery and will stay on the eye longer.

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How Are They Inserted?

Punctal plugs come in different types and sizes to suit different people. The eye doctor or optometrist will first examine the eyes and tear ducts to confirm they are suitable to go ahead. Once suitability has been confirmed and the correct punctal plugs have been selected, the eye specialist will first numb the eye to avoid irritation during insertion. The plug is inserted using forceps and is not usefully painful but can feel slightly uncomfortable. If the duct is too small, and the smallest plug is already selected, then it might be necessary for the eye specialist to use a lacrimal dilator to open the duct enough to insert the plug. The procedure is carried out in a consultation room while the patient is awake and sat in a chair and normally only takes a few minutes.

What Are the Types of Plugs?

As mentioned above there are different types of plugs depending on what is most suitable for the eye.

1. Temporary Punctal Plugs

These are normally recommended when plugs haven’t been used before. They are made of collagen which naturally dissolves into the body after a few weeks of insertion. If these temporary plugs work well, then it may be recommended to try permanent plugs.

2. Permanent Punctal Plugs

These are usually made of either silicone or acrylic and do not dissolve. These plugs can stay in the duct for years but can sometimes fall out as they sit at the opening of the tear duct. If needed these type of plugs can be removed, this is possible by using forceps.

3. Intracanalicular Punctal Plugs

These plugs are another type of permanent plug but inserted further down into the tear duct and can again last for years. These plugs can be removed but surgery is usually required to remove them, so this type of plug is usually only used when someone has had a good result from the previous types of plugs and when the ophthalmologist deems it suitable.

Conclusion

While punctal plugs are a good treatment for dry eye disease and work well, they are not suitable and do not always work for everybody. They are a good option to discuss with an eye doctor, who will assess suitability and whether they will help. Most of the time punctal plugs do need to be used in conjunction with other dry eye treatments but can help reduce reliance on other treatments, such as artificial tears.

About the expert

Mr Samer Hamada | Consultant Ophthalmologist and Corneal Surgeon

MD, MSc, DO (hons), FRCSEd, FRCOphth I am Samer Hamada, founder and consultant ophthalmic surgeon with over 20 years’ experience in ophthalmology. I am a world-renowned specialist in cornea, cataract and refractive surgery. I’m not only a leading surgeon but also the only dual fellowship trained in corneal diseases in children from reputable institutions in the UK. At Eye Clinic London I work closely with other consultant ophthalmologists, optometrists and orthoptists to achieve the best outcomes for our patients. Our main aim is to make sure our patients get the safest and best treatments available to them. We put your safety before anything else so you can rest assured that if you choose us you will be in the best and safest hands.

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