Punctal Plugs: Purpose, Procedure, and More

Medically reviewed by Timothy J. Legg, PhD, CRNP on January 24, 2017Written by Ann Pietrangelo on January 24, 2017

Overview

Punctal plugs, also called lacrimal plugs, are tiny devices used to treat dry eye syndrome. Dry eye syndrome is also known as chronic dry eyes.

If you have dry eye syndrome, your eyes don’t produce enough quality tears to keep your eyes lubricated. Symptoms of dry eye include:

  • burning
  • scratchiness
  • blurry vision

Ongoing dryness prompts you to produce more tears, but they’re mostly water and don’t adequately moisten your eyes. So, you make more tears than your eyes can hold, which often leads to overflow.

If you make too many tears and your eyes are tearing up a lot, it may be a sign that you have dry eye syndrome.

Dry eye syndrome can often be improved with the use of over-the-counter artificial tears combined with a few lifestyle changes. If that doesn’t work, your eye doctor can prescribe medication like cyclosporine (Restasis, Sandimmune).

Learn more: Eye drops for dry eyes »

If lifestyle changes and eye drops don’t improve your symptoms, your eye doctor may recommend punctal plugs. The plugs are inserted into the tear duct opening (punctal) in the corner of your eye. This is the area where tears usually drain through the back of your nose and throat.

The plugs form a blockade so the tears can’t flow out, keeping your eyes lubricated.

How can I prepare for this procedure?

Before getting punctal plugs, you’ll need a comprehensive eye examination.

If you and your doctor agree that punctal plugs are your best option, you’ll have to decide on the type. Temporary punctal plugs are made of collagen, and they’ll dissolve after a few months. Plugs made of silicone are meant to last for years.

The plugs come in different sizes, so your doctor will need to measure the opening of your tear duct.

There’s no need for general anesthesia, so you won’t have to fast. In fact, there’s nothing you need to do to prepare for the procedure.

How are punctal plugs inserted?

Punctal plug insertion is done on an outpatient basis.

You’ll remain awake during the procedure. This noninvasive procedure requires nothing more than a few anesthetic eye drops.

Your doctor will use a special instrument to insert the plugs. You might have some minor discomfort, but it’s generally not painful. From beginning to end, the procedure should only take a few minutes. Once the plugs are in, you probably won’t be able to feel them.

What will recovery be like?

You should be able to resume normal activities, like driving, immediately.

Temporary plugs dissolve on their own within a few months. Your dry eye problem may return, though. If that happens and the plugs were helping, the permanent kind may be a better option for you.

Your doctor will instruct you on how often you should return for follow-up. If you have severe dry eye, or infections due to punctal plugs, your doctor may need to check you a few times a year.

What are possible complications?

Even a simple procedure can cause complications.

One possible complication is infection. Symptoms of infection include tenderness, redness, and discharge. Medication can clear up most cases of infection. If not, the plugs may have to be removed.

It’s also possible for the plug to move out of place, in which case it must be removed. If the plug falls out, it’s probably because it was too small. Your doctor can repeat the procedure using a larger plug.

Punctal plugs can be removed as easily and quickly as they’re put in. If the plug has moved out of position, your doctor might be able to flush it out with saline solution. If not, a small pair of forceps is all that’s needed.

What’s the outlook?

There’s no cure for dry eye. The goal of treatment is to ease symptoms.

A 2015 report by the American Academy of Ophthalmology noted that punctal plugs improve symptoms of moderate dry eye that don’t respond to topical lubrication. The report also concluded that serious complications don’t happen very often.

If you do have problems with your plugs, let your doctor know right away. Infections should be treated as soon as possible. The plugs can be safely removed if necessary.

Tips for managing dry eye syndrome

Whether or not you have punctal plugs, here are a few tips that might improve symptoms of dry eye syndrome:

  • Rest your eyes. If you stare at electronic screens all day, make sure you blink often enough and take frequent breaks.
  • Use a humidifier to keep indoor air moist.
  • Use an air filter to minimize dust.
  • Stay out of the breeze. Don’t face fans, air conditioning vents, or other blowers that can dry your eyes.
  • Moisten your eyes. Use eye drops several times a day. Choose products that say “artificial tears,” but avoid those with preservatives.
  • Shield your eyes outdoors by wearing glasses or sunglasses that fit snugly on your face.

Symptoms of dry eye can fluctuate so you may sometimes need to modify treatment options.

If those measures aren’t enough to ease symptoms, see your doctor to be certain you get the correct diagnosis. Dry eye can sometimes be a symptom of underlying disease or a side effect of medication.

Consider asking your doctor the following questions:

  • What’s causing my symptoms?
  • Are there any lifestyle changes I can make to improve symptoms of dry eye?
  • Should I use eye drops, and if so, what kind should I choose?
  • Should I try prescription eye medication such as cyclosporine (Restasis, Sandimmune)?
  • How long do I have to use eye drops before I know that they aren’t working?
  • If I have punctal plugs, will I still need to use eye drops?
  • Should I give up my contact lenses?
  • Should I be concerned if I can see or feel the plugs?
  • How often will I need to have the plugs checked?
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