Put a Plug in It

What can we do you for, if you still suffer from dry eyes symptoms, even after squeezing bottle after bottle of artificial tears onto your eyeballs? To answer my dear reader, Avitalle, on a comment posted 2/17/10, I would like to address the topic of punctal plugs. And my answer to you comes from an age-old idiom: waste not, want not.

Your eyelids serve not only the important function of lubrication (call them cornea squeegies), they also contain a little toilet bowl that drains those tears. This little toilet bowl is called the punctum and it marks the beginning of the tear drainage system. Each one of the four lids contains a little punctum -- take a look at the nasal portion of your eyelid margins in the mirror and you will see these little holes. The puncta (plural form of punctum) drain excess tears by a complex vacuum mechanism that synchronizes perfectly to suck tears down the drain with each blink. Tears are then are emptied into the vast dumping ground of your nasal cavity via the tear ducts. In other words: what the eyelid giveth (tear glands) the eyelid taketh away (puncta). It is a sort of deity, perhaps a dictator, that can make or break your tear film.

If your eyes are as dry as Avitalle's, you are probably not producing enough aqueous to keep the cornea moist. So, it seems only logical to throw a wrench into those puncta and show them who's boss. Plugging up the puncta allows your eyes to keep all the tear volume they naturally produce and then some.

How does it work? Punctal plugs are tiny silicone wonders that can be deployed straight into the punctal opening, where they expand and stay until they fall out (typically 6 months to a year later). Planting the punctal plugs (do I get points for alliteration?) takes approximately a minute a punctum, is completely painless, and can be done in the comfort of your friendly neighborhood eye clinic. Depending on the severity of the symptoms, just the lower, or both upper and lower puncta can be plugged.

Most of my patients are very satisfied with the procedure and return with a healthy tear lake on follow-up. There is a small (but vocal) minority who can feel the plug if they look in its direction (Don't do that!) Rest assured though, the plugs can be removed as easily as they were placed, and they are completely inert otherwise (i.e. they do not elicit any immune response or allergy).