In the U.S., millions of people experience dry eye, and many of these people do not experience any symptoms.

Punctal plugs are an option for treating dry eyes. These tiny silicone devices plug the tear duct openings. In the lower and upper eyelids, these plugs go into the tiny openings. Once in place, the plugs work to conserve artificial and natural tears. (Learn More)

There are different plug types you and your doctor will choose from. (Learn More) The best option depends on the cause of your dry eye and its overall severity.

The procedure to place the plugs is not overly difficult. Your eye doctor will take measurements to ensure they are using the right plug size. (Learn More)

The doctor will go over the possible side effects and other issues that can occur when you have these plugs inserted. (Learn More) Make your medical history known and follow all aftercare instructions to reduce the risk of complications.

man and daughter holding kite

Purpose of Punctal Plugs

These plugs, also referred to as lacrimal plugs, are something your doctor might recommend if other dry eye treatments fail to provide relief. When your eyes are chronically dry, this can result in several uncomfortable symptoms.

  • Stringy mucus
  • Eye redness
  • Trouble wearing contact lenses
  • Watery eyes
  • Burning, scratchiness, or stinging
  • Light sensitivity
  • Feeling like there is something in your eye
  • Trouble driving at night
  • Eye fatigue
  • Blurry vision

Dry eyes can also put you at risk for certain vision health complications. These complications may include:

  • Eye surface damage that can lead to corneal surface abrasions, vision problems, eye inflammation, and corneal ulcers if you do not treat it.
  • Eye infections since tears play a major role in protecting the eye surface against infection.
  • Difficulty reading and completing other daily activities.

Types of Punctal Plugs

There are two primary plug types. The semi-permanent type is usually made from a silicone or another long-lasting material. The dissolvable type is made from collagen and other materials that the body is able to absorb on its own.

The dissolvable or temporary type of punctal plugs can last for up to several months, but some dissolve within a few days. The doctor might choose the dissolvable type to see if these plugs can help your eye dryness. If they do, your doctor may discuss placing the semi-permanent plugs into your eyes.

Your doctor might also consider the dissolvable type for after certain procedures to aid in eye recovery.

Preparing for the Procedure

The first step is getting a comprehensive eye examination. There are many tests the doctor might recommend based on your symptoms, overall health, and the history of your visual health.

The tests associated with a comprehensive eye examination may include:

  • Visual acuity. This test is done to evaluate how well each eye sees.
  • Keratometry. This test measures the corneal curvature.
  • Preliminary tests. This testing may include evaluations of your color vision, side or peripheral vision, depth perception, eye muscle movements, or how the pupils respond to light.
  • Refraction. This test is done to look at the lens power necessary to help you see clearly with any refractive error you might have.
  • Eye movement testing. This testing will help your doctor to see how well your eyes are able to move, work, and focus together.
  • Supplemental testing. If any eye examinations produce abnormal results, your doctor may need to perform additional testing to confirm the results.
  • Eye health evaluation. These tests are more comprehensive and might be ordered if simpler tests do not provide a reason for your vision health problems.

Inserting Punctal Plugs

Inserting these plugs can help the eyes to maintain more moisture. This is because they reduce the approximately 25 percent of tears that evaporation takes each day. The key is to ensure proper insertion so you reap the benefits.

This is a noninvasive, outpatient procedure. The doctor will apply anesthetic eyedrops before inserting the plugs to keep you comfortable.

A special instrument helps the doctor to insert the plugs. The process is usually not painful, but minor discomfort is possible.

It only takes a few minutes to insert each plug. You typically cannot feel them once the doctor puts them into place.

The doctor will measure and visualize the area to ensure the right plug type and size. They will determine if you need plugs in the upper or lower lid. In some cases, they will place plugs into both. The plug goes into the puncta after dilating the opening of the tear duct.

In some cases, the doctor will place the plug into the canaliculus of a tear duct so it is deeper. This type is referred to as an intracanalicular plug.

Possible Side Effects

It is rare to experience serious problems or side effects with punctal plugs. However, side effects can include:

  • Loss or displacement of the plug.
  • Excessive watery eyes and tearing.
  • Eye infections.
  • The plug going deeper into the drainage channels of the eye, resulting in a blockage.

The possible side effects are things that doctors can treat. If the plug causes a blockage or becomes displaced, the doctor can usually remove it. Plug replacement or removal may benefit excessive watering or tearing. Doctors can prescribe antibiotics for infections.

Recovery and Outlook

man using eyedropper on left eye

Your doctor will give you specific recovery instructions, but most people can resume normal activities right away.

Within a few months, the temporary plugs will dissolve. The permanent type may be removed or left in place, depending on the severity of your eye dryness.

A report in 2015 concluded that serious complications are not common with this procedure. This same report said that when someone’s dry eye does not respond to topical lubrication, these plugs are a viable alternative.

Should you experience a problem with your plugs, they are removable. Removing them is relatively simple, so make sure your doctor knows about the problem right away.

You might also consider taking a few basic steps every day to further reduce eye dryness.

  • Blink often and rest your eyes.
  • Filter your home’s air.
  • Moisten your eyes.
  • Use a humidifier.
  • Avoid air conditioning blowing directly into your eyes.
  • Protect your eyes from the sun.

If you have dry eyes, do not hesitate to talk to your doctor. This dryness can be uncomfortable, and it puts you at risk for various eye health issues.

Punctal plugs may be a good choice to ensure better lubrication of your eye for improved comfort and health.

References

Combating Dry Eye With Punctal Plugs. (January 27, 2017). Optometry Times.

Dry Eyes. Mayo Clinic.

Post-LASIK Dry Eye. (August 1, 2012). Expert Review Ophthalmology.

Comprehensive Eye and Vision Examination. American Optometric Association.

Plug the Drain With Lacrimal Occlusion. (June 15, 2016). Review of Optometry.

Punctal Plugs for Dry Eyes. All About Vision.

Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome. (August 2015). American Academy of Ophthalmology.