Punctum Plugs for Dry Eye

Dry Eye

Your eyes constantly produce tears containing natural infection fighting antibiotics. Blinking ensures tears cover the eye’s surface before being sucked through two small holes in the nasal corner of your eyelids. These are the tear duct openings or puncta that drain tears to the nose and throat.

If your tear glands make insufficient tears, or they drain away too quickly, the tear film is spread too thinly over the eye’s surface. If your tear glands produce enough tears but are of poor quality, they evaporate too quickly before the next blink comes along. Either way, dry spots appear and cause irritation.

Depending on the cause, Dry Eye can be treated as a temporary problem or a long-term condition. Either way, tears must be conserved or supplemented in order to provide relief.

For less severe dry eye cases, artificial tears offer immediate relief. However, in cases of more persistent dry eye symptoms, closure of the tear duct openings may be the best option. This conserves precious tears by restricting drainage. Your eyes are bathed with your own natural tears without the bother of constantly supplementing the tear film with artificial drops.

Trial closure of the tear ducts – Collagen Plugs

If your dry eye has an evaporative component to its cause, the case for closing the tear ducts is not clear-cut. For these patients, trial dissolvable plugs are fitted where the patient returns one week later for assessment of their experience.

A drop of anaesthetic is instilled into the eye and a tiny dissolvable collagen plug is painlessly inserted into your lower tear duct. The entire procedure is performed in the consulting room in only a couple of minutes. Many patients report immediate improvement in comfort.

Collagen plugs dissolve within one week. If during this test period you experience relief from dry eye symptoms, you may wish to proceed with the long-term comfort afforded by permanent tear duct closure.

Permanent and semi-permanent closure of the tear duct with plugs

Closing the tear drainage ducts makes a lot of sense. In effect your own natural tears treat your own dry condition. Unless you have purely evaporative dry eye, plugs will help – it’s just a question of by how much. Some patients find they can stop using eye drops altogether.

There has recently become available a special type of collagen plug which takes around 2 months to dissolve. This has become cameronoptometry’s preferred solution even for patient requiring permanent closure of the ducts as they can more easily be replaced if lost or removed if necessary or adjusted to provide a more comfortable fit in the tear duct.

Permanent punctal occlusion, the medical name for closing the tear duct, can be achieved by

  • Laser “welding”: Reversible? NO
  • Cauterisation “burning”: Reversible? NO
  • Non-dissolvable silicone punctum plugs: Reversible? YES

Punctal plugs act very much like a stopper in a sink. Placing a tiny silicone insert into the tear duct prevents precious tears being lost. As the tear reservoir builds – the self-lubricating process begins.

Plugs are the least invasive of the long-term solutions to dry eye with a very high rate of success. They can be inserted easily and painlessly and are medically inert. They can easily be removed if too much tearing is produced in the event your dry eye condition improves at a later date. They are ideal in contact lens cases.

Different plug designs are available in a range of sizes so each patient requires individual assessment. If you are interested in trying punctum plugs or want more information on them or any aspect of dry eye, contact us at the practice


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5 St. Vincent Street, Edinburgh EH3 6SW
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