How Long Do Permanent Punctal Plugs Last
Here is everything you need to know about punctal plugs, how they work, and what to expect during insertion

Punctal plugs do not last indefinitely, although some last longer than others depending on the type and material:

  • Permanent punctum plug: Made of permanent material, such as silicone or acrylic, lasting 3-4 years or more.
  • Semi-permanent: Made of copolymers lasting 2-6 months.
  • Temporary punctum plug: Made of collagen and may dissolve within 7-10 days.

Here is everything you need to know about punctal plugs, how they work, and what to expect during insertion.

What are punctal plugs?

Punctal plugs (tear duct plugs) are tiny medical devices used to treat chronic dry eyes. They work by restricting the tear duct (puncta) of the eye, which stops tears from draining from the eye. This raises the level of tears on the ocular surface and provides immediate long-term relief from dry eyes. There is less dependency on artificial tears because natural tears are retained.

The bottom two puncta are the most common locations for plugs. However, some people may need plugs in all four ducts (two lower and two upper). Tiny, soluble, or nonsoluble plugs are put into the tear drainage ducts, acting as a dam. As a result, tears move to the surface of your eyes and the eyes feel moist.

Punctal plugs can also help lessen or eliminate the most common source of contact lens discomfort.

Punctal plugs may be suitable for you if making lifestyle changes, artificial tears, prescription eye drops are insufficient to resolve symptoms of dry eyes.

When are permanent punctal plugs used?

In many cases, the optometrist will recommend starting with a temporary dissolvable punctal plug. If the temporary plugs prove to be useful, permanent plugs are used. 

Both temporary and permanent punctal plugs can be removed if there are any negative side effects. 

There are several plugs available, and some may work better than others, be more pleasant, or last longer for an individual. Furthermore, the hazards of plugs differ based on the substance and location where they are implanted.

What are different types of punctal plugs?

Punctal plugs come in three main varieties:

  • Collagen plugs: Collagen plugs may be swapped out for a more durable option if symptoms of dry eye are reduced.
  • Silicone plugs: These plugs are easier to remove. In general, silicone punctal plugs are effective for long-term dry eye therapy.
  • Intracanalicular plugs: Intracanalicular plugs are inserted deep into the tear duct, unlike silicone plugs, which rest at the duct's surface. Although this stops them from falling out, surgery may be required if they ever need to be taken out.

Different sizes and types of punctal plugs are used for different reasons:

  • Slanted or low-profile cap: Provides additional stability while maintaining comfort
  • Tapered: Helps maintain the punctal plug in its right position
  • Umbrella: Clearly visible and can be removed easily
  • Hollow: Inside is hollow and plug is made to fit the form of the tear ducts
  • Reservoir: Keeps tears in place, preventing them from falling out

QUESTION

What causes dry eyes? See Answer

How are punctal plugs inserted?

Punctal plugs can be inserted with or without numbing drops, although in many cases no anesthetic is required.

  • Punctal plugs can be placed in the lower, upper, or both eyelids. 
  • Before inserting a plug, your doctor will measure the aperture of your tear duct to determine the amount of plug required to obstruct your tear duct.
  • The way the plug is inserted is determined by its form and shape.
  • Some plugs come with dedicated inserters, whereas others must be inserted using forceps or other tools. The type of plug influences the place of insertion.
  • Once wet, the plugs will expand to entirely fill the aperture. 
  • The procedure may take less than 15 minutes and some patients report experiencing improved symptoms right away.
  • Some plugs can be seen after they have been implanted. Others are implanted further into the tear duct and are not visible.

When punctal plugs are implanted, you may experience slight pain. Once the plugs are in place, most people do not notice them, although you may feel a slight sensation that something is there.

5 possible complications of punctal plugs

  1. Excessive tearing or epiphora: If the punctal plug overperforms, it may result in watery eyes. If you have excessive tearing, the doctor can replace the current plug with one that has a smaller size or a more suitable shape.
  2. Displacement: Rubbing your eyes may occasionally cause unintentional dislodgment. This is a frequent problem, especially with silicone plugs.
  3. Infections: In rare cases, punctal plugs may cause eye infections. If this happens, oral or topical antibiotics can be used to treat the infection. Other times, it may be necessary to take the plugs out.
  4. Swelling or pain: Punctal clogs can sometimes advance into the drainage canals, but this is uncommon. The resultant blockage of the ducts may result in discomfort, pain, or inflammation.
  5. Allergic reaction: Some people may be allergic to the material of the punctal plugs. If allergic reactions occur, supportive treatment is used and plugs may be replaced.

How do I care for punctal plugs?

Follow all the recommendations by your doctor regarding care for your punctal plugs.

  • Avoid rubbing your eyes to avoid eye irritation and pain.
  • Use a clean, moist applicator with a cotton tip to remove any dirt from the corner of the eyes.
  • Do not panic if you lose or dislodge your plug. It can be replaced. Never attempt to repair a loose plug yourself.

Because the plugs are made to be taken out, it is possible that you could misplace or accidentally dislodge the plug. Contact your doctor if you suspect your plug has been misplaced or dislodged or if you feel any pain or discomfort due to the insertion of the plugs.

What is the outcome of patients with punctal plugs?

According to some studies, punctal plugs can help retain eye moisture in 91% of patients and reduce symptoms in 77% of patients. The additional moisture enhanced eyesight in 43% of patients. 

However, effective treatment of chronic dry eyes, does not preclude you from being a candidate for laser-assisted in-situ keratomileusis (LASIK) surgery.

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Medically Reviewed on 8/5/2022
References
Image Source: iStock image

Punctal Plugs. https://www.aao.org/eye-health/diseases/punctal-plugs

Punctal Plugs. https://www.med.umich.edu/1libr/Ophthalmology/comprehensive/PunctalPlugs.pdf

How Do Punctal Plugs Work? https://www.webmd.com/eye-health/punctal-plugs