Punctum plugs are one way of treating dry eyes.

What are punctum plugs?
A punctum plug, also known as a punctal plug, is a small medical plug that is inserted into the tear ducts of the eye to prevent the outflow of tears. These ducts are located on the inside of the eye, towards the nose. Each eye has two tear ducts - one in the upper eyelid and one in the lower eyelid, with the majority of tears flowing through the lower duct. (Figure 1) In cases of severe discomfort, both canals can become blocked, sometimes allowing the use of eye drops to be reduced or even stopped.

Two types of punctum plugs
There are two types of punctum plugs: temporary and permanent ones.
Temporary plugs are typically made of collagen and dissolve after days to months. They are usually used during eye surgery to ensure sufficient eye moisture postoperatively or to try out punctum plugs.
Permanent plugs are usually made of silicone or acrylic and range in size from 0.2 mm to 0.9 mm. It is important to choose the right size and some manufacturers offer measuring devices to determine the size. Depending on your needs, the plugs can also be partially permeable to only reduce tear flow and not completely block it. The plugs can remain in place for years and can be easily removed by the ophthalmologist at any time.

How are the plugs inserted?
The punctum plugs are usually inserted on an outpatient basis after a thorough examination by the ophthalmologist. This can be done within a few minutes and is painless.

Possible risks and side effects
The risks of using Punctum Plugs are low, but may include eye irritation, excessive tearing and infection due to a stagnant film of fluid in the eye. Most patients report that the eye irritation subsides quickly on its own after insertion.

Figure 1
The tear system of the human eye

Kierstan Boyd: Punctal Plugs; (2023, May 03), Tear Drainage System (Figure), aao.org, www.aao.org/eye-health/treatments/punctal-plugs

What is the experience and what alternatives are there?
The use of punctum plugs is promising and many patients report positive results. An alternative, more permanent solution is cauterization of the tear ducts, in which the ducts are permanently closed by heat. Nevertheless, punctum plugs can be used for many years without any problems.

Kierstan Boyd: Punctal Plugs; (2023, May 03), www.aao.org/eye-health/treatments/punctal-plugs
Punctal Plugs; (2023, September 14), my.clevelandclinic.org/health/treatments/25249-punctal-plugs