Puctal Plugs

Overview

Puctal plugs are tiny, biocompatible devices that can be inserted into tear ducts to block drainage. This increases the eye’s tear film and surface moisture to help relieve certain forms of dry eye. Also known as punctum plugs, lacrimal plugs or occluders, these devices often are no larger than a grain of rice.

Puctal plugs usually are considered when non-prescription or prescription eye drops fail to relieve your dry eye condition.

Two general types of tear duct plugs are:

Temporary or dissolvable Puctal plugs usually last from a few days to as long as several months. Dissolvable, temporary Puctal plugs sometimes are used to determine if the treatment works for your dry eye condition. If so, then semi-permanent Puctal plugs might be considered.

How Are Puctal Plugs Inserted in Tear Ducts?

Depending on the type of puctal plug selected, your eye doctor first may use a special instrument to measure the size of your tear duct openings (puncta). This helps determine the proper size of the puctal plug needed to block drainage within the channel and to keep it securely in place.

Many eye doctors need only a lighted, close-up examination of your eye to determine the size and type of Puctal plug you need. In some cases, a one-size-fits-all style of puctal plug may be used.

To prepare you for the procedure, some eye doctors use a local anesthetic before inserting the puctal plug. In many cases, no anesthetic is needed.

Each eyelid has one punctum, located at its inner margin near the nose. Puctal plugs can be inserted in the puncta of the lower lids, the upper lids or both. An instrument may be used to dilate the tear duct opening for easier insertion.

Some Puctal plugs are inserted just into the puncta so they still can be seen and mechanically removed if necessary.

Other puctal 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. In the uncommon case where removal is needed, intracanalicular plugs are extracted by flushing them out.

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

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