Punctal Occulsion Therapy

Punctal plugs are tiny, biocompatible devices inserted into tear ducts to block drainage. These increase the eye’s tear film and surface moisture to relieve dry eyes. These devices often are no larger than a grain of rice.

Punctal plugs usually are considered when non-prescription or prescription eye drops fail to relieve dry eyes.

Two general types of tear duct plugs are:

• Semi-permanent, typically made of long-lasting materials such as silicone. Some punctal plugs are inserted just into the puncta so they still can be seen and mechanically removed if necessary.Other punctal plugs are inserted deeper into the canaliculus, where they are out of sight. These types of tear duct plugs — technically called intracanalicular plugs — do not protrude from the punctum. They are not seen or felt, and automatically conform to the shape of the cavity.
• Dissolvable, made of materials such as collagen that the body eventually absorbs. Temporary or dissolvable punctal plugs usually last from a few days to as long as several months.Dissolvable, temporary punctal plugs sometimes are used to determine if the treatment works for your dry eye condition. If so, then semi-permanent punctal plugs might be considered. They may also be in circumstances such as preventing dry eyes after LASIK.

How Are Punctal Plugs Inserted in Tear Ducts?

In many cases eye doctors may need only a lighted, close-up examination of your eye to determine the size and type of punctal plug you need. In some cases, a one-size-fits-all style of punctal plug may be used. In other cases, a special instrument may be used to measure the size of the tear duct opening.

To prepare you for the procedure, our doctors use a local anesthetic drop before inserting the punctal plug.

Each eyelid has one punctum, located at its inner margin near the nose. Punctal plugs can be inserted in the puncta of the lower lids, the upper lids or both.

Other than minimal initial discomfort, you should not feel the punctal plug once it is in place. Immediately after the procedure, you should be able to drive yourself home and resume normal activities.

Punctal Plugs Side Effects and Problems

Usually, punctal plug insertion is uneventful and rarely involves serious side effects or problems.

Excessive tearing (epiphora) can occur when the punctal plug does its job too well. In this case, you may need to visit your eye doctor for removal of the plug or replacement with a different type to better control the amount of tears in your eyes.

Displacement or loss of the plug is common and can occur when people rub their eyes excessively and accidentally dislodge the device.

When Should Punctal Plugs Be Removed?

While semi-permanent punctal plugs can last indefinitely, they also are easily removed.

If you feel discomfort or suspect you have an eye infection or other complication, be sure and notify your eye doctor.

If removal is considered necessary, your eye doctor may use forceps to grasp and extract the plug. Another method of removal involves flushing with a saline solution, which forces the punctal plug to exit into the nose or throat where tear ducts drain