Punctal Plugs

Punctal plugs are small devices inserted into the tear ducts to help retain moisture on the surface of the eye. They are commonly used to treat dry eye syndrome by blocking the drainage of tears, allowing for increased lubrication. These plugs can be temporary or permanent, depending on the patient's needs and the recommendation of an eye care professional. Overall, punctal plugs can significantly improve comfort for those suffering from dry eyes.

A little insight

Punctal occlusion for dry eye is performed when the tear volume is low and works by reducing drainage of the tears down into the nose and then to the throat. This can be achieved either by inserting a carefully measured medical grade silicone implant into the punctal opening of either the lower or sometimes the upper eyelid.It is also possible to cause the same effect by inserting an implant further down the drainage system, in which case its termed an intra-canalicular implant, or by inducing surgical shrinkage of the punctal opening by thermal or radio-frequency cautery. Examples of these procedures are shown in our punctal occlusion video below.There are a number of reasons why punctal plugs have become the most popular method of treating dry eye. They have a very high rate of success; and the optometrist can insert them easily and painlessly. They are also reversible if too much tearing is produced.They can be easily removed if no longer required. Plugs are usually effective for at least 2-3 years. Punctal plugs often enable a patient who would otherwise have to give up wearing contact lenses, to keep doing so.

In the first of these pictures below we can see a patient having a punctal plug fitted in the lower puncta of the of her right eye and in the following one we can see the plug in situe, occluding the tear drainage and thereby increasing the volume of the tear reservoir available to wet the eye surface. IPL also increases the tear volume by restoring the quality of the lipid layer and reducing tear evaporation. IPL also has the advantage of normalising the tear salinity and electrolyte levels.

The following video shows the punctual plug fitting procedure.

Some people have a puncta that is too large or lax to hold a punctal implant - in these cases we often consider punctal cautery as an option. This procedure sounds worse than it really is. The punctal opening is strongly numbed with anesthetic beforehand and the thermal or radio-frequency tip is only in contact with the lid tissue for a second or so. Cautery is a more permanent form of occlusion in most cases and so can work out cheaper in the long run than having punctal plugs fitted as these may need replacing as the punctal opening enlarges as the tissues age.

Dry eye patients should also consider the option of Intense pulsed light treatment, also known as IPL, which also increases tear volume, this time by reducing tear evaporation loss. IPL also reduces inflammation and restores the tear osmolarity (saltiness) which then further improves tear quality by improving the health of the mucous secreting conjunctival goblet cells.

Patients interested in having Amniotic Membranes or Punctal Implants fitted or IPL will need to have a specialist therapeutic dry eye evaluation first to ensure that they are the most appropriate option and whether other treatments are also required. Please phone or email our practices for an appointment.

Punctal Plugs

A little insight

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