How Do Punctal Plugs Work?

If your dry eyes itch, burn, or sting, punctal plugs may be just the thing to relieve your symptoms. How well they work depends on what causes your problems and what kind of plug you and your doctor choose.

How Do They Work?

Your doctor inserts the plug into your tear duct to block the natural flow of tears from your eye, down the duct, and into your nose. This keeps tears, eyedrops, and medicine on your eyes for longer and helps keep your eyes moist.

What Are the Types of Plugs?

There are three kinds of what you doctor will call lacrimal plugs.

Collagen plugs: These dissolve over a period of days, weeks, or months. Your doctor might suggest them first to see if plugs will help at all. If they do, she may want to replace them later with a longer-lasting model.

Punctal (silicone) plugs can be a long-term dry eye treatment. When your doctor inserts one into your duct, the tip will be barely visible on your eyelid. That makes it easier to remove if you have problems or need a new kind of treatment. The most common issue with punctal plugs is that they can fall out.

Intracanalicular plugs are the longest-lasting type. They go farther into the duct and can’t be seen on the surface of your lid. They can stay in place for many years. One drawback: Removal may require surgery.

How Are They Inserted?

It’s simple. Your doctor can do it in her office. She’ll numb your tear duct and then push in the plug with forceps. She may need to expand the duct opening with a tool called a lacrimal dilator.

The plugs come in various shapes, sizes, and colors. Your doctor will determine the best fit for you.

How Do You Prepare?

At the first visit, you’ll get a full eye exam. Your doctor will ask for a history of your symptoms. She may want to measure for signs of dryness and check your tear flow and quality.

Knowing the cause of your dry eyes is important. Plugs don’t work for everyone. They’re best if your eyes don’t produce enough tears or you have low-quality tears. Your doctor will probably start you on artificial tears or drops. If that doesn’t relieve your problems, plugs may be the next step.

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What Are the Risks?

Plugs don’t usually cause serious problems. But watch out for:

  • A scratchy feeling in the inner corner of your eye. Most people get used to it.
  • An allergy to the plugs, which is rare. The most common materials used to make them are bovine collagen, silicone, and acrylic polymer.
  • A plug that sticks out or is the wrong size. It can rub against the surface of your eye. Sometimes the damage is so minor, you don’t notice it. That’s why follow-up exams are crucial even if you think nothing is wrong. The doctor may put a stain in your eye to check for problems.
  • Watery eyes. Sometimes the plugs work too well. Your doctor might call this epiphora. You can decide if it’s worth the tradeoff to relieve your dry eyes.
  • Inflammation or irritation on your eyelid or tear duct. Call your doctor right away if you notice these common problems with intracanalicular plugs. It’s rare, but the irritation could be so severe, your doctor will decide to remove them. Sometimes they can be flushed out, but if that doesn’t work, you may need surgery. The risks include scarring and damage to the tear duct. In severe cases, your doctor may have to replace the duct with an artificial one.

The Bottom Line

If you have moderately dry eyes, lacrimal plugs are a simple way to relieve your symptoms and improve your vision and quality of life.

While the risks are low, it’s important to talk to your doctor about them ahead of time so you know what to look for. Call your doctor at the first sign of trouble.

WebMD Medical Reference Reviewed by Brian S. Boxer Wachler, MD on February 20, 2018

Sources

SOURCES:

Mayo Clinic: “Dry eyes: Diagnosis & treatment,” “Dry eyes: Symptoms & causes,” “Punctal plugs.”

Review of Optometry: “Plug the Drain with Lacrimal Occlusion.”

American Academy of Ophthalmology: “Considerations for Lacrimal Occlusion in the Moderate Dry Eye Patient,” “Intracanalicular Plugs: Use With Caution.”

Ophthalmology: “Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome.”

University of Iowa Health Care: “Removal of intracanalicular plugs.”

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