Punctal Plugs

Question 1

what tear film layer does punctal plugs help maintain

Answer 1

aqueous layer

Question 2

what is a collagen punctal plug used for

Answer 2

diagnostic tool: if pts symptoms improve w/ plugs, there is an aqueous component to dry eye
-temporary, lasts days or 4-6 wks

prognostic: trial to permanent plugs to be sure pt won’t suffer from epiphora (excessive watering)

Question 3

what are the 2 different designs of the silicone plug

how can you remove each

Answer 3

1. punctal occlusion design: intended to block tear drainage completely
   - removed w/ forceps
2. intracanalicular design: titrate tear flow outward
   - removed by irrigation through cnaliculus into lacrimal system

Question 4

what are the differences to silicon plug insertion and collagen plug insertion

Answer 4

silicone: insert plug into vertical canaliculus w/ a slight rotating motion

Question 5

what are the advantages and disadvantages of the intracanalicular design

Answer 5

advantage: unlikely to fall out, better comfort
disadvantage: unable to visualize if the plug completely passes the system at any time, must rely on symptom changes, unable to remove w/ forceps, use irrigation

Question 6

what are the contraindications to punctal plugs

Answer 6

1. do not perform during active dacryocystitis
2. avoid use in patients w/ chronic eye infection
3. do not use for patients w/ silicone hypersensitivty