Punctal plugs prevent tears from being moved to your nose and throat. This means that more tears are available to lubricate your eyes. They don’t make dry eyes drier — ideally, they only make more lubrication available in the eyes, not less.
However, inflammation proteins called cytokines are sometimes released when you have dry eye. If cytokines are present in your tears, then punctal plugs may make the situation worse by not allowing them to be cleared.
Anti-inflammatory dry eye medications such as cyclosporine (Gengraf, Neoral, Sandimmune) and lifitegrast (Xiidra) are helpful in these situations. They should be started before or at the same time as punctal plug placement.
No. Punctal plugs don’t affect the actual production of tears, so they don’t lead to more or less secretion.
The natural production of tears happens in your lacrimal glands — almond-shaped structures above the outer corners of your eyes — and accessory lacrimal glands underneath your eyelids.
These aren’t affected by punctal plugs, which are placed near the inner corner of your eyes in the tear ducts.
Punctal plugs often help dry eyes by allowing tears to remain present around the eye for longer rather than being moved to the nose or throat.
Punctal plugs require typical eyelid anatomy in order to work. If your eyelids are too loose or turned out, the punctal plugs will have less of an effect.
Also, if inflammation or fast evaporation are causing your dry eyes, then the punctal plugs alone won’t address these issues.
Punctal plugs work best for aqueous-deficient dry eye. Aqueous-deficient dry eye happens when there aren’t enough tears for the eye to stay moist.
Punctal plugs work less well if:
- your eyelids are an abnormal shape
- there’s active inflammation in your eyes
- your tears evaporate too quickly
The beneficial effects of punctal plugs are almost immediate. Most people notice a difference within a few days.
The day the plugs are placed, there can be mild soreness that typically goes away within a few hours.
Depending on the design of the plugs used, you may feel a foreign body sensation if part of the plugs rubs against your eyes.
If you have active inflammation in your eyes, then punctal plugs may make this worse, as the inflammation signals remain around the eye without being cleared.
Punctal plugs can be removed when necessary.
Removal usually involves using a special tool called forceps. A healthcare professional will use forceps to take out the plugs while you sit in front of a slit lamp in their office. Slit lamps are microscopes that use beams of light to allow a closer look at your eyes.
A different design of punctal plug, which sits in the tear duct below the surface, can be removed by flushing the area through with saline.
However, most of the time these measures aren’t necessary because these plugs eventually fall out on their own after about 6 months.
If you or your doctor are concerned about how the plugs will be tolerated, a collagen plug can be placed to check how much of an effect to expect. These are plugs made out of dissolving protein and last about a month.
You may consider removing the punctal plugs if you experience noticeably worse foreign body sensation from the plug rubbing against your eyes.
Another reason a doctor may recommend removing the plugs is if an infection is suspected at the site of the plug or in the tear duct below it.
Dr. Vicente Diaz is an ABMS board certified ophthalmologist at Yale Medicine and Yale Health who specializes in ocular inflammatory and infectious diseases. He is also the chief of ophthalmology at the Yale Health Plan and director of ophthalmology for the Bridgeport Hospital Burn Unit, where he oversees the care of all patients with Stevens-Johnsons syndrome, a rare and potentially lethal disease.