eye2eye interview with the Punctal Plug

Posted on June 9, 2011 · Posted in Dry Eye, Eye Health

Dry eye affects millions of people worldwide.  Symptoms can vary from a mild, temporary irritation all the way up to significant visual compromise due to scarring of the surface of the eye.  The traditional therapy most know about and employ is over-the-counter (OTC) artificial tears.  These can be effective, but a common complaint is the inconvenience of having to put drops in the eyes multiple times a day.

There are other options.  A dry eye sufferer does not have to “settle” for an inconvenient treatment.  One such option is blockage of the opening in the eyelid where tears filter off the surface of the eye with a device called a punctal plug.  We offered one of our plugs a chance to share its story and it half-heartedly obliged.

FV:  Hi Punctal Plug!  Great that you could be here.

PP:  Thanks.  Not sure where else I’d be, though….I’m here in the office until I’m in someone’s eye.

FV:  Can you talk a little bit about that?

PP:  Well I basically sit in the cabinet in a sterile—

FV:  I’m sorry….I mean can you talk a little bit about why you are in someone’s eye?

PP:   Oh…we’re kind of like a stopper in a drain or a cork in a bottle of wine.  When one of us is put into position in the eyelid, we stop a patient’s tears from draining out.

FV:  And if you stop the tears from flowing out through the drain,  where do they go?

PP:  That’s the fun part.  They stay on the eye longer and make people more comfortable.  As you know, the eye has two openings for tears to flow out.  One in the upper lid and one in the lower lid.  You generally put us in the lower opening, but I don’t really know why.

The Lacrimal System

FV:  Gravity and tear mechanics, really.  Tears flow across the surface of the eye and downward such that about 2/3 of our tear volume flows out through the lower opening (called a punctum).  By closing the lower punctum, we increase the time a person’s natural tears stay on the eye, while also leaving an area for tears to leave through the upper one.

PP:  Makes sense.

FV:  Good.  It is a pretty straightforward idea.  I think it’s important to note for our readers that you have never been in an eye because generally once you are put in there, you either stay in there forever or are removed and discarded.

PP:  Don’t you mean “reader”?

FV:  Listen…I’m not sure where the hostility is coming from, but we’re trying to get your story out there for people to know you can help them.

PP:  I’m sorry.  It’s just been hard waiting for my chance.  Being at the bottom of the supply isn’t good for one’s confidence.

FV:  But it must be nice to see so many of your family members helping patients?  Whether it’s your silicone plug siblings or your collagen plug cousins, you all do such good work for people.

PP:  I guess you’re right.  I was talking last night with a collagen plug and neither of us knew how we were different.  What’s the answer?

FV:  Collagen plugs are temporary.  We put them in and they last for about 7-10 days which allows the patient to “test drive” punctal occlusion.  If their symptoms are eliminated or improved during the trial run, more permanent silicone or alternate material plugs are used.  Even these “permanent” plugs can be removed if necessary.  But the overall goal is to eliminate or significantly reduce a person’s dependency on artificial tears in the fight against dry eye.

PP:  Is the procedure painful?

FV:  Nope.  Every case is a little bit different, but the vast majority of patients don’t even require anesthetic for it to be comfortable.

PP: Can I show everyone a home video of my work?

FV:  I think that would be fun.  We should probably warn people that the video shows a medical procedure and, although there is no blood or cutting, some might find it difficult to watch.  What you will see is a plug being inserted into the puntum of the right lower lid of a patient.

video courtesy of Star Ophthalmic.