Punctal plugs, also known as punctum plugs, occluders, or lacrimal plugs, are small biocompatible devices that are inserted into the tear ducts to block drainage. This plug helps increase the tear film and surface moisture of the eye to help relieve discomfort due to dry eye.
These devices are as small as a grain of rice and are distinguished into two general types:
Semi-permanent, made of longer-lasting materials like silicone.
Dissolvable, made of absorbable materials such as collagen.
How to Insert Punctal Plugs Into the Tear Ducts?
Your doctor will have to measure first the size of your tear duct openings or the puncta to determine the perfect size of the punctal plug needed. A perfect-fitting punctal plug is necessary to ensure blockage of the drainage and keep it securely in place.
In common cases, an anesthetic is not needed. However, there are some patients who have low pain tolerance which requires administering anesthetics before inserting the punctal plug. For smoother insertion, an instrument may be utilized to dilate the tear duct opening.
Punctal plugs are inserted in the puncta where it can be seen and removed easily or into the canaliculus, where they are hidden. These intracanalicular plugs are not seen or felt and these automatically conform to the shape of the cavity. In rare cases where removal is required, intracanalicular plugs can be extracted by flushing them out.
Aside from slight initial discomfort, punctal plugs are not felt and you should be able to return to normal activities immediately after it is inserted.
Side Effects and Problems of Punctal Plugs
Punctal plugs rarely have any side effects. However, excessive tearing (epiphora) and watery eyes can be experienced when punctal plugs do its job too well. This may require a visit to your eye doctor and a replacement of the punctal plugs.
Loss and displacement of punctal plugs are common occurrences especially after rubbing the eyes and accidentally dislodging the device from its place. Eye infections such as canaliculitis may occur in rare reactions to punctal plugs. Dacrocystitis with swelling, pain, discomfort, and other uncommon complications may also occur when the plug accidentally migrates deeper into the drainage channels of the eyes away from its target area.
If you feel any discomfort or suspect an eye infection or complications from your punctal plugs, notify your eye doctor immediately. If removal is necessary, your eye doctor may extract the plugs through forceps or by flushing it with a saline solution to exit the nose or throat.