Doctors use a procedure called punctal occlusion surgery to insert punctal plugs, which may be a temporary or long-term solution. The procedure is straightforward, but there is a slight risk of side effects. It is possible to remove the plugs if necessary, but serious problems are rare.
In this article, we look at how punctal plugs work, what to expect during and after the insertion procedure, and possible side effects.
What are punctal plugs?
Punctal plugs sit in the tear ducts to prevent tears draining away.
Punctal plugs are tiny medical devices that sit in the tear ducts in the eyes to help prevent tears draining away, which helps to keep the eyes moist.
A doctor may recommend punctal plugs for people with a condition called dry eye, which can cause the following symptoms:
- constantly itchy and dry eyes
- burning eyes
- blurry vision
- eyes that are quick to tire
People with chronic dry eye do not produce enough tears and the tears they do make are low quality. This can cause the eyes to feel dry throughout the day, which then stimulates the body to produce more tears.
These tears are often very watery and do not hydrate the eye well, but the constant signal to the body to create more tears leads to continuous leakage from the eyes throughout the day. Punctal plugs help to lubricate the eyes, which can alleviate the symptoms of dry eye.
How do they work?
Punctal plugs work much like the drain stopper in a bathtub. They are small plugs that sit in the tear ducts in the eyes.
They work by blocking the tear drainage channel that drains the liquid from the surface of the eye. Instead of escaping, the fluid will stay on the surface of the eye which maintains lubrication throughout the day.
These plugs work with both natural and artificial tears and may reduce the need for eye drops.
There are several different types of punctal plug available, but the punctal occlusion procedure is the same for all of them.
Before the procedure
A doctor will examine the eye before considering punctal plugs.
Doctors will perform a physical eye examination before inserting the punctal plugs. They will ask about a person's symptoms and any relevant medical history they may have.
They may also inspect the eyes for signs of dryness and check the tears that the eye is producing. This is important, as plugs will not work for everyone.
After diagnosing dry eye, a doctor will usually prescribe artificial tears or other treatments to see how the eyes react. If these are not effective after a set amount of time, the doctor may consider using punctal plugs.
If the doctor believes that plugs are the right choice, they will discuss the different types of plug with the individual.
Types of plugs
A doctor may recommend one of the following types of plugs depending on the individual's needs:
- Temporary plugs. Many doctors will recommend using temporary plugs initially to see how the body reacts. They are collagen plugs, which dissolve naturally in the body and will fade after a few weeks or months. This gives doctors time to monitor how the person reacts before deciding if a more permanent option would be suitable.
- Silicone or acrylic plugs. The first permanent punctal plugs that doctors will try typically consist of silicone or stable acrylic. They can last for years, but it is also possible to remove them if the body reacts negatively. These plugs may be visible, though usually not enough to be distracting.
- Intracanalicular plugs. These plugs go further into the tear duct and may stay in place for many years, offering a more permanent solution to leaking eyes. As they sit more deeply in the duct, surgery may be necessary to remove them. Doctors will, therefore, usually try other plugs first to check how a person reacts to them.
Inserting the plug
After choosing the most suitable type of punctal plug, the doctor will make an appointment to insert them. They will need to use the right size and shape for the person's eyes. The process is quite simple, and many doctors insert the plugs in their office.
A doctor will first numb the tear duct to prevent irritation. They will then insert the plug directly into the tear duct using small forceps. If the duct is too narrow, they may need to use an instrument called a lacrimal dilator to open it so the plug can fit in.
The entire process is typically over within a few minutes. Some people may experience slight discomfort during the insertion, but the plugs are not usually painful. Once the process is over, most people cannot feel them.
Inserting punctal plugs is not a major procedure, and recovery is usually quick. Once people adjust to having the plugs, they can return to using their eyes as normal.
First-time plugs are typically collagen ones, which will dissolve within a few months. If the plugs were helping, symptoms of dry eye might return after this time. This would demonstrate the need for a more permanent solution.
Doctors may ask patients with more permanent plugs to visit every few months so they can monitor eye health and any reactions the body is having to the plugs. This is particularly essential if a person is prone to eye infections with the plugs or has severely dry eyes.
In some cases, the eyes do not respond well to the plugs, and it may be necessary to remove them.
A common side effect is a scratchy, slightly irritating sensation in the eye.
Serious complications are not common with punctal plugs. However, some people may experience side effects.
The most common side effect is a scratchy, slightly irritating sensation in the corner of the eye. Most people acclimatize to this feeling or find that it disappears after a while.
Other side effects can include:
- Inflammation. Sometimes the plugs can irritate the tear ducts or cause inflammation for more extended periods of time. Anyone noticing these symptoms should contact their doctor for a checkup. It may be best to remove the plugs, as the inflammation could lead to scarring or other damage in the tear duct.
- Allergic reaction. While not common, it is possible for someone to have an allergic reaction to the insertion of the plugs. The body may even reject the plugs entirely, in which case removal will be necessary.
- Watery eyes. Punctal plugs can work too well in some cases and lead to a person having watery eyes constantly. In this case, a doctor can suggest other treatment options.
- Plugs that stick out. This is usually due to a plug being the wrong size. Plugs may rub against the surface of the eye or the eyelid, and can even fall out of the duct. This is one of the reasons doctors recommend regular checkups following the insertion.
Removing punctal plugs depends on the type.
- collagen plugs will dissolve on their own in a matter of weeks or months
- silicone plugs sit closer to the surface of the eye and doctors will need forceps to remove them
- intracanalicular plugs sit deeper in the duct and require surgery for removal
When to see a doctor
People with moderate or chronic dry eye may want to make an appointment with their doctor to see if punctal plugs are right for them.
People who have tried artificial tears or other eye drops and had little success may respond well to plugs.
Side effects from punctal plugs are rare but possible. Anyone experiencing any side effects should make their doctor aware immediately to avoid any lasting damage to the eye.
There is no cure for chronic dry eye but, by using treatment methods such as punctal plugs and eye drops, many people can achieve long-term relief from their symptoms.