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Punctal Plugs

by Milan Eye Center

by Dr.Cassandra Baker

Burning, stinging, gritty, watery, blurry, light sensitive, red. What umbrella do all these symptoms fall under? The one catching all our patient’s tears of course—dry eye!

Dry eye is a condition, not just an unfortunate symptom that can be experienced daily. It can be caused by many different factors: age, sex, systemic conditions, eyelid morphology, medications, LASIK, hormones, our environment, the list could go on and on. There are two types of dry eye: evaporative and tear film insufficiency. Evaporative dry eye occurs when the layers of the tear film are not sufficiently keeping tears on the surface of the eye as long as they should—they evaporate off. Tear film insufficiency is due to an inadequate amount of tears on the ocular surface.

Because there are so many causes, stages, and treatment options for dry eye, patients often have a personalized management plan. Dry eye therapy can include any combination of artificial tears, warm compresses, lid scrubs, omega 3 supplements, oral antibiotics/anti-inflammatories, and topical anti-inflammatory eye drops. However, this list is just the tip of the dry eye iceberg. One form of dry eye management that is unlike any other is the punctal plug.

Punctal plugs are tiny, biocompatible implantable devices (temporary or permanent) that are placed in the punctum—the opening to our drainage system of the eye. We have two puncta in each eyelid—nasally, in the upper and lower corner of the eyelid. Punctal plugs function as a drain stopper just like a sink stopper does—keeping tears on the surface of the eye longer and therefore increasing surface moisture. Placing the plug in the lower drainage opening allows for the best results due to gravity pulling most tear flow towards and through the inferior punctum. In severe cases, or those that show significant improvement, a second plug can also be inserted into the upper punctum. Punctal plugs were initially thought to be best utilized in tear film insufficiency patients as they increase the amount of tears on the ocular surface. However, they can, and should be utilized on any dry eye patient if the physician feels they would provide symptomatic relief.

The thought of inserting a “plug” into the eyelid could be cringe worthy. However, it should be comforting to know that there is no pain during this process, they can be placed in the matter of a minute or two, have relatively few side effects, and the procedure is done in the office—no special appointment needed. Some patients have a mild awareness of plugs initially, but this typically is fleeting. This awareness also is virtually insignificant with temporary plugs. Temporary plugs are made of collagen and will dissolve over the course of a few months and fit completely inside of the punctum. Using a temporary plug is helpful to determine if permanent plugs will be effective as well as in situations when dry eye is short-lived— i.e. LASIK induced dry eye. Permanent punctal plugs are made of silicon and rest on the outer surface of the punctum much like a drain stopper does. Removal of punctal plugs can be done easily at any time should it be necessary. Lastly, punctal plugs are a great adjunct to many other dry eye regimens and when used together allow for much symptomatic relief.

If you suffer from dry eye and are tired of carrying that umbrella around, the team at Milan Eye Center would love to help put a (drainage) stopper to your symptoms!

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