Other Treatment Options

Punctum Plugs

Punctal plugs are small devices that are used to block the tear drainage channel in the inner corner of your eye. The plugs are inserted into the tear duct opening, which is called the puncta. Tears normally drain out from this channel through the back of your nose and into the back of your throat. The punctal plug acts as a dam by preventing tears from flowing out. This helps keeps your eyes moist with your own tears. They can also help artificial tears last longer.

Punctal plugs can be inserted for a short amount of time or permanently. Temporary punctal plugs are typically made out of collagen, a material that is found in bone and skin. These plugs naturally dissolve over time. Permanent punctal plugs are usually made out of silicone.

Punctal Plugs

How Are Punctal Plugs Inserted?

Punctal plugs can be inserted in the lower eyelid, upper eyelid, or both. Before your eye care practioner inserts a plug, he/she will measure the opening of your tear duct to determine the size of plug that you will need to block your tear duct. He/she will sometimes use topical anesthetic drops (numbing drops) before the procedure, but in many cases, no anesthesia is needed. The exact way your eye care practioner inserts the plug depends on the design and shape. Some plugs come with special inserters, but other types are inserted with forceps or other instruments. The location of insertion also depends on the type of plug. You can see some plugs after they are inserted. Others are inserted deeper into the tear duct and will not be visible when you look in the mirror.

You may have some mild discomfort while the punctal plugs are inserted, but it will be very brief. Most people cannot feel the plugs once they are in place. If they do feel them, it is a mild sensation that is not bothersome. You can resume normal activities and drive yourself home immediately after the procedure.

Punctal plugs inserted

How Are Punctal Plugs Removed?

Temporary punctal plugs dissolve naturally and do not require removal. Permanent punctal plugs do not need to be removed unless you are bothered by them or develop an infection (which is extremely rare).

Removing punctal plugs is usually very easy. Your eye care practitioner may take out the plug using forceps. If the punctal plug has migrated deeper into the tear duct and cannot be removed with forceps, the plug can be flushed out using saline solution.

What are the Risks of Punctal Plugs?

Punctal plugs rarely cause serious side effects, but they do have some risks. Possible risks include:

  • The plug falling out, this is the most common problem
  • Excessive tearing, the plugs can be removed if this happens
  • Eye infection, the plug can be removed if this happens

Flow Controllers

Flow controllers are a tiny hollow insert which are placed in the tear duct, holding it open.

These Flow Controller plugs are used for draining tears in the treatment of Epiphora caused by zero flow while the rest of the lacrimal duct is normal and keeps a blocked punctum open assuring normal tear regulation.