What do you mean ‘plug’ my tears!?
Why put the plug in?
If you suffer from more severe dry eye symptoms due to a lack of tear production or excessive evaporation your optician may suggest blocking your tears natural drainage duct or punctum. This will help retain your tears for longer and reduce your dry eye symptoms such as gritty, sore, dry, itchy or red eyes. This process is referred to as punctum plugging or punctal occlusion.
Where to find your puncta (plural of punctum)?
You are continuously producing tears which travel down a series of ducts in the eye lids to your eyes. The tears are spread over the eye with each blink and eventually either evaporate or drain out via the puncta. There is an upper and lower punctum in each eye, both found near the corner of your upper and lower eyelid near your nose – on the inside edge. The puncta are only small, about 0.6mm, but if you look carefully in the mirror you can see them. Here’s a great little video which shows the structure clearly.
How is plugging achieved?
This is achieved by inserting a tiny little punctal plug, the size of a grain of rice, into the puncta to block the channel below. Either the upper, lower or both ducts can be plugged. This is a relatively common procedure which an experienced dry eye specialist can perform quickly and easily.
Don’t panic – it won’t hurt!
If your optician suggests this to you don’t worry as it really is a quick and painless procedure. If you are particularly squeamish your eyecare professional may apply a drop of local anaesthetic to the area for good measure. The plugs are soft and once in place you will not feel them. The good news is that many people feel the benefits straight away but for others it is more gradual. In fact. There are scientific studies which show punctal plugs can be used to help improve contact lens wearing comfort where feelings of dryness is reducing comfortable wearing times.
Is it permanent?
There are 2 types of punctal plugs in common use – a naturally dissolving one made of the same material as dissolving sutures - and semi-permanent ones made from medical grade silicone . The dissolvable plugs break down over a period of a 3-6 months depending on the make. These are typically used after eye surgery to keep these eyes moist or to see if plugging is going to work for you. The plugs made from silicone don’t break down and are typically replaced every year or so – they can easily and painlessly removed at any time by your eye care professional. You might be interested to know that the plugs come in different sizes too and so are fitted to the size of your puncta to help avoid them coming out too easily.
It is worth noting that silicone plugs can be seen if you look, but are hardly noticeable as they are so small. The dissolvable plugs go deeper into the canal below the duct and so cannot be seen, consequently these are a little trickier to fit and cannot be easily removed before they dissolve.
What else should you know?
You may still need to use an eye drop, but if you do, it will usually be less frequently. You also need to look after your eye hygiene a little more by cleaning away sleep from the eye using a cleansing foam or eyelid wipe.
And try not to rub your eyes (never a good thing to do anyway!) as this might dislodge the plug! But don’t worry your eyecare professional can replace it.
Like most things there can be side effects such as eye irritations, plugs falling out or sometimes too many tears! Your eye professional will explain this to you and monitor your progress.
Looking after your tears
As you get older you will tend to produce less tears or tears of a poorer quality. This can make you more susceptible to tired, sore or dry feeling eyes. But there are some simple things you can do to look after your tears. Try to avoid drying environments by turning down the air-conditioning and central heating, drink plenty of water, resting your eyes regularly from screen work, making sure you include oily fish rich in omega-3 in your diet and avoid using make-up with chemical irritants in. This might not aways be possible so make sure you keep some artificial tears at hand, such as HydraMed, to use before dry eye symptoms start i.e. before getting on a flight or at the start of a long day in the office. The Dry Eye Zone offers a range of tried and tested solutions to keep your peepers looking and feeling their best.
Punctal occlusion or plugging can only be carried out by a qualified eye care professional.
If you are experiencing dry, tired feeling eyes then you should ask the advice of your eye care professional.
L. Jones et al. TFOS DEWS II Management and Therapy Report. The Ocular Surface xxx (2017) 580e634
Youngje Sung, Jong Seo Park, Helen Lew. Measurement of lacrimal punctum using spectralis domain anterior optical coherence tomography. Acta Ophthalmologica. First published: 28 December 2016 https://doi.org/10.1111/aos.13322
NHS Manchester Royal Eye Hospital. General Ophthalmology Services
The American Journal of Ophthalmology. Punctal plugs. By Kierstan Boyd. Reviewed By James M Huffman, MD. Mar. 08, 2022 https://www.aao.org/eye-health/diseases/punctal-plugs
Giovagnoli D, Graham SJ. Inferior punctal occlusion with removable silicone punctal plugs in the treatment of dry-eye related contact lens discomfort. J Am Optom Assoc. 1992 Jul;63(7):481-5.
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