Dry eye disease is an increasingly common condition with many different treatment approaches. The first line of treatment for dry eyes is usually lubricating artificial tears. However, for individuals with moderate to severe dry eye disease, lubricating eye drops alone may not be enough to relieve symptoms. Punctal plugs can be a treatment option in these cases. Punctal plugs are small implants that are placed in the duct that drains tears with the goal of increasing the time the eye’s natural tears remain on the corneal surface and improving ocular comfort. They are an especially useful treatment option for those who may not produce an adequate amount of natural tears.
The punctum is the small opening near the inner corner of the eye that opens into the tear duct, where tears are drained away from the eye’s front surface. Punctal plugs are very small implants made of a biocompatible material that are inserted into the punctum. By blocking this drainage passage, the tears remain on the corneal surface for a longer period of time, which can improve corneal lubrication and ultimately decrease symptoms of dryness, irritation, and burning associated with dry eye disease.
Depending on the case of dry eye, punctal plugs can be permanent or temporary. In some situations, your eye care provider may choose to insert a temporary plug initially to ensure the device is effective and improves dry eye related symptoms. These “temporary” plugs are made of collagen and dissolve on their own in a matter of weeks. There is also an option of “permanent” plugs, made of a more durable and longer lasting material that can be effective for years at a time.
If you and your optometrist decide that punctal plugs may be a viable treatment option, your doctor can simply insert the implant in-office during a quick and painless treatment procedure. Your doctor will take some measurements in order to appropriately choose the size and type of plug that needs to be implanted. Then, the doctor simply uses their traditional microscope and a pair of surgical tweezers to gently insert the plug into the punctum. It only takes seconds to complete and is very safe. The only real risk associated with punctal plug application is the risk of an allergic or adverse reaction to the material of the plug being inserted, in which case the device can be quickly and safely removed.
Once the plug is inserted into the punctum, there is no associated pain or discomfort, and normal daily activities can be immediately resumed. Typically people report an improvement in symptoms over the week after having punctal plugs inserted. Your doctor will likely require you to return for a follow-up appointment to ensure the insert is properly placed and working appropriately. However, beyond this initial follow-up, punctal plugs are a very low maintenance treatment option. Oftentimes, punctal plugs are used in conjunction with additional therapeutic approaches, like lubricating eye drops or medications to help improve symptoms of dryness.