The Role of Punctal Plugs for Dry Eyes

Punctal plugs are something we use to help treat Dry Eye Syndrome.  

This syndrome is a multifactorial problem that comes from a generalized decrease in the amount and quality of the tears you make.  There is often both a lack of tear volume and inflammation in the tear glands, which interfere with tear production and also cause the quality of the tears to not be as good.

We make tears through two different mechanisms.  One is called a basal secretion of tears, meaning a constant low flow or production of tears to keep the eye moist and comfortable.  There is a second mechanism called reflexive tear production, which is a sudden flood of tears caused by the excitation of nerves on the eye surface when they detect inflammatory conditions or foreign body sensations. It is a useful reflexive nerve loop that helps wash out any foreign body or toxic substance you might get in the eye by flooding the eye with tears.  Consider what happens when you get suntan lotion in your eye.  The nerves detect the irritation that the lotion creates, and your eyes quickly flood with tears.

That reflex mechanism is how some people get tearing even though the underlying cause of that tearing is dry eye.  They don’t produce enough of the basal tears, the eye surface gets irritated and then the reflex tearing kicks in and floods their eyes, tearing them up.  Once that reflex is gone then the eye dries out again and the whole cycle starts over.

One of the treatments for dry eyes is to put a small plug into the tear drainage duct so that whatever tears you are making stay on the eye surface longer instead of draining away from the eye into to the tear drainage duct and emptying into your nose.

There are several different types of punctal plugs.  Some are made of a material that is designed to dissolve over time.  Some materials dissolve over two weeks, while others can last as long as 6 months.  There are also plugs made out of a soft silicone material that are designed to stay in forever.  They can, however, be removed fairly easily if desired or they can fall out on their own, especially if you have a habit of rubbing near the inside corner of your eye.

One of the big advantages of punctal plugs is that they can improve symptoms fairly rapidly - sometimes as quickly as a day.

The long-term medical treatment for dry eyes such as Restasis, Xiidra or the vitamin supplement HydroEye can take weeks or months to have a good effect.

On the other hand, plugs simply make you retain your tears for a longer time; they don’t help the underlying inflammation.  That is where the medical treatment comes in.  Sometimes it is useful to use a temporary plug for more instant relief while you are waiting for the medical treatment to work.  Sometimes there is clearly just a deficiency of tears and not much inflammation and the plugs alone will improve your symptoms.

All in all, punctal plugs are a safe, effective, and relatively easily-inserted treatment for dry eyes.

Article contributed by Dr. Brian Wnorowski, M.D.

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