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Punctal Plugs

punctal plugsDry eye disease (DED) is a very common condition associated with symptoms such as burning, redness, itching, or (somewhat surprisingly) watering. If you don’t experience it, you may think of it as a minor annoyance. If you do… you know better. First line treatments we recommend are generally naturopathic, including good hydration, warm compresses, artificial tears, Omega 3 Fatty Acids such as found in fish oil, and eyelid hygiene. When these approaches fail to provide sufficient relief, we may next suggest “punctal plugs. Puncta are holes in the inner corners of the lids through which tears drain. Plugs are… well, plugs!

Tears are produced in the lacrimal glands, located around the outer edge of your brow line. Blinking squeezes tears out and spreads them across the eye’s surface. The tears then drain into a very small opening called a “punctum” (plural – puncta) located in both the upper and lower lid inner corners. They then move through the nasolacrimal system, where they ultimately drain down the back of the throat.

Punctal plugs are small (about 2mm long and usually .4 to .8 mm wide) cylindrical devices made of collagen. They are inserted usually into the lower puncta of both eyes, preventing the tears from draining as quickly and keeping them on the eye’s surface longer. They do not replace other dry eye therapies but can be a great addition. Because the plugs are made of collagen, they will dissolve in 3 months, and need replacing every 3-6 months or so.

If punctal plugs are a good option for you, we recommend a trial run first, and insert temporary plugs that dissolve within 1 week. This ensures you like them, and they actually relieve symptoms. At the 10 day follow-up, if they have been successful, plugs lasting approximately 3 months will be inserted. For some people, this limited treatment course, along with compresses, artificial tears, etc.. may be enough to control symptoms. For others, plug replacement every 3-6 months may be necessary.

In addition to plugs, prescription eye drops, and in-office heating and expression of oil glands in the lids may be helpful when first line treatments don’t do the trick.