Punctal Plugs for Dry Eyes

Punctal plugs stop tears from draining out of the eye by either permanently or temporarily blocking the tear ducts. This can be very useful in treating certain types of dry eye

Why Punctal Plugs?

Punctal plugs can help alleviate the symptoms of dry eye in patients diagnosed with low tear volume (aqueous deficiency) if used in conjunction with other treatments such as artificial tears. Punctal plugs would be considered if other treatments have not sufficiently improved the symptoms of dry eye.

How do Punctal Plugs work?

Each eye has a punctum in the upper eyelid and the lower eyelid which allow tears to drain into your nose. Punctal plugs work by permanently or temporarily blocking or reducing the drainage of tears from the eye into the tear duct. If due to the dry eye disease the overall production of tears is lower than ideal then punctal plugs can help to trap the tears on the surface of the eye and thus help alleviate some dry eye symptoms.

What is involved in fitting Punctal Plugs?

Fitting punctal plugs quick and painless. First our optometrist will perform an InflammaDry test, an in-house laboratory test, to prove whether or not inflammation is present in your tears. This test involves taking a small sample of your tears to look for MMP-9, an inflammatory marker. If a negative result is shown then we can proceed with punctal plug fitting.

Before applying punctal plugs to your eye a small drop of topical anaesthetic is applied to the eye and the eyelid to numb the area for added comfort. Our optometrist then uses punctal gauges to measure the size of your punctum. This allows us to select the correct size and design of punctal plug that best suits your needs. The plug is then gently placed within the punctum using a special applicator.

There are two types of punctal plug – (1) temporary synthetic punctal plugs and (2) Permanent/Semi permanent silicone punctal plugs.

Synthetic temporary punctal plugs

Synthetic temporary punctal plugs dissolve over a period of approximately 3 months. Our optometrists often use temporary plugs to evaluate whether permanent plugs will be beneficial in treating dry eye or for patients who have a temporary dry eye. Temporary plugs can hardly be felt as they are positioned within the tear duct and therefore cannot fall out. Furthermore, temporary plugs are invisible as they are lodged within the tear duct.

Due to the excellent safety and comfort provided by three-monthly synthetic temporary punctal plugs many of our patients choose to simply have them replaced every 3 months. We have a punctal plug direct debit scheme that allows you to pay monthly and have plugs replaced as required.

Permanent/Semi permanent silicone punctal plugs

Silicone plugs do not dissolve, they are fitted on top of the opening of the tear duct. When our optometrists insert the plug into your tear duct, the tip will be barely visible on your eyelid. Although they are called ‘permanent’ plugs, they can be removed. Sometimes removal is necessary if there is discomfort. However, the most common issue with permanent plugs is that they can fall out or can be felt in the eye.

How long do Punctal Plugs last?

Synthetic temporary punctal plugs need replaced every 3 months.

Semi-permanent or permanent silicone plugs can be left in place for many years, however can cause infection due to formation of biofilm. We therefore recommend replacing them 12-24 monthly.

Who should consider Punctal Plugs?

  • Patients diagnosed with dry eye disease as a result of aqueous deficiency.
  • Patients deemed to have low tear volume.
  • Individuals who are struggling with symptoms of dry eye despite

Who shouldn’t consider?

  • Patients with an active infection
  • Patients with active inflammation or a positive InflammaDry Test
  • Patients with allergic conjunctivitis
  • Patients with active blepharitis – IPL and BlephEx treatment should be conducted first.
  • Known allergies to materials of punctal plus

What should I do after my IPL treatment?

With synthetic temporary punctal plugs you should not be aware of feeling the plug. Your symptoms will hopefully slowly improve over the first week. In the case of permanent/semi-permanent silicone punctal plugs you may be mildly aware of the plug in the corner of your eye, although this normally settles down after a few days.

Our optometrists will provide you with a bespoke treatment plan and arrange a suitable follow-up to assess the success of the treatment.

How do I get started?

If you have already been diagnosed with low tear volume then you can simply make an appointment for a punctal plug assessment. If you have unexplained dry eye symptoms and are considering punctal plugs as a treatment option then booking an evaluation within our dry eye and blepharitis clinic will allow us to make an accurate diagnosis and offer an effective evidence based treatment plan that may include punctal plugs.