blocking the tear drainage duct of the eyelids with punctual plugs has been around since the
1970s but the question is is this something that's still a viable option for dry eye disease today
let's focus in hey howdy everybody this is Dr. Neal Guymon, Dr. EyeGuy, with the channel that
keeps your eyes healthy and your vision clear with this video being part of a series of videos all
about dry eyes so definitely check out the link to the video playlist in the description below
now punctual plugs has been around for years it's been a tool in the toolbox of dry eye treatments
and so let's go over exactly what they are and what they do now we all have holes in our eyelids
called puncta with a little canal that drains all the tears out now this is actually a good thing
when we blink our eyelids actually force tears out it cleans debris out out of these canals and
into the nose now the idea with dry eyes if you're able to control or block the drain with a punctal
plug you block a punctum then the idea is that it'll keep the tears on the surface of the eyes
longer now usually when you're talking about punctal plugs usually a doctor will plug the
bottom punctum that's because about 80 percent of the tears drain out the bottom 20 percent out of
the top but in more severe dry eye cases they may plug both puncta now there are mainly two
different types of puncta plugs temporary punctal plugs usually made out of collagen can last weeks
to months and will dissolve when it's all said and done now this video is actually a video of
my right eye getting a punctal plug placed in there now usually when a doctor does this they
may use a topical numbing drop anesthetic just to make it more comfortable not necessary though
it's not painful to get the pump to plug in there they also might use a dilator tool to open up the
punctum a little bit wider to make it easier and then they'll use forceps or an insertion tool to
put the puncta plug in its place the second type of plug is considered a permanent punctal plug and
can last years usually made out of silicone and usually has a little cap on there to sit flush
with the punctum now one thing about punctual plugs is sometimes they can be irritating to
the patient 99 of the time the patient won't feel the punctual plugs inside the eyelids
but sometimes especially with the permanent punctal plugs they can be sitting up a little bit
and actually rub on the surface of the eyeball and cause irritation or a foreign body sensation but
usually in that case that silicone permanent plug can be removed or it can be pushed down a little
bit to sit flush with the pumpkin there's also a slight chance of an infection or an allergic
response if you're allergic to the material of the puncta plug but usually this can be cleared
up with either antibiotic treatment or removing the punctual plugs if needed now just really quick
if you have any questions about punctual plugs or have had any experience with punctual plugs
definitely share it in the comments below i'm sure a lot of people would love to hear it also
hit that like while you're down there now here's one of the biggest contraindications to punctual
plugs like i said the idea with puncta plugs is to block the tears from draining out of the eye you
want to keep the tears on the eyes longer because that person has dry eyes now sometimes the tears
have poor quality poor consistency might have inflammation inflammatory markers within the tears
and so sometimes you don't want to block those tears you want those tears to drain out if you
block the tears and keep the tears on the surface of the eyes it actually might make the condition
worse might make the symptoms worse now the big question where do punctual plugs fall in place in
the vastly evolving options of dry eye treatments now this is something that you will want to work
with your eye doctor very closely you want to know specifically what type of dry eye disease
that you have now with me personally i've become more selective and more specific on what patients
i recommend punctual plugs to nowadays with every year it seems like there's more and more dry eye
treatments that target specific dry eye diseases like meibomian gland dysfunction evaporative dry
eye disease aqueous deficient dry disease certain medications and treatments targeting specific
layers of the tear film lipid oil layer aqueous water layer mucous layer certain medications
and treatments can target more specifically now punctual plugs is still a big tool in the toolbox
of dry eye disease that i still use but you might find some people that when they get punctal plugs
it will be the answer to their dry eyes or significantly reduce their dry eye symptoms
but you'll also find people that don't notice any difference with punctual plugs or might make the
condition worse now one of the biggest takeaways is to make sure that you check with your doctor to
see if punctual plugs is a good option for you now if you're curious about dry eyes dried symptoms
dry eye treatments definitely check out my playlist right there make sure you're subscribed i
have a lot more future videos coming out about dry eyes I'm Dr. Neal Guymon, Dr. EyeGuy, stay focused