Treatment options for dry eye disease are extensive and can vary based on the severity of symptoms. For many with moderate to severe dry eye disease, first approach treatment options such as artificial tears are not effective enough. In these cases, punctal plugs may be a viable option. Punctal plugs are small biocompatible inserts that are carefully placed in the tear duct by an eye care professional in order to retain natural tears on the corneal surface, keeping the front of the eye more nourished and comfortable. For people suffering from aqueous deficient dry eye disease, in which not enough natural tears are produced, punctal plugs can be a highly effective treatment option.
What are Punctal Plugs?
Punctal plugs are small biomedical devices that rest in the tear duct, preventing excessive drainage of tears. By blocking tear drainage, punctal plugs address dry eye symptoms by keeping the cornea lubricated and preventing dryness, burning, and irritation. Punctal plugs allow both artificial and natural tears to remain on the corneal surface longer, extending the relief of dry eye symptoms.
Punctal plugs can be temporary or permanent. In many cases, your optometrist will recommend beginning with a temporary dissolvable punctal plug. These implants, made from collagen, are designed to slowly dissolve over a matter of weeks or months. They may be the initial treatment selection to identify whether or not punctal plugs are effective in treating your specific symptoms. If the temporary plugs prove to be beneficial, permanent plugs may be selected. Permanent punctal plugs are made of a more durable biocompatible material such as silicone or acrylic, and are designed to last for multiple years. Both temporary and permanent punctal plugs are able to be removed if an adverse reaction occurs.
What’s the Next Step?
If you and your doctor agree that punctal plugs are a viable treatment option for you, the next steps are quick and painless. In order to correctly select an appropriate size plug, the doctor may measure the size of your punctum, or the small hole on your lower lid margin that drains your tears. Once the plug that is to be inserted is selected, the doctor will simply use a microscope and a pair of surgical tweezers to carefully insert the plugs into the punctum. This process is absolutely painless and is completed in a matter of minutes. The only significant risk associated with the procedure is an adverse or allergic reaction to the plug; if this occurs, the device can be easily and quickly removed. Once the punctal plug is inserted into the tear duct, there is no pain, discomfort, or awareness. Daily activities can immediately resume, and many people are able to notice a marked improvement of symptoms within the first day or two. Your doctor may ask you to return for a follow-up appointment shortly after insertion to ensure that symptoms are improving and the devices are securely placed. Beyond this, punctal plugs only require monitoring at an annual exam and are a very low-maintenance method of dry eye treatment.
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