Punctal occlusion is an effective treatment for many common conditions of the eye, and therefore an important staple of the well-equipped ophthalmology practice.

Punctal plugs help retain tears, keeping the eye moist and healthy while reducing symptoms of dry eye. Fortunately, there are a number of effective punctum plugs on the market–but (unfortunately) sorting through them can be tedious.

Here we’ll help you identify the best punctal plugs to keep on hand in your office.

Punctal plugs: an ophthalmological necessity

Tear duct plugs, of course, provide an elegant and relatively simple treatment option for chronic dry eye (often in conjunction with Restasis treatment), Sjogren’s syndrome, punctal stenosis and other eye conditions. Punctal or canalicular plugs may also be used after refractive (LASIK) surgery.

Lacrimal plugs can be used adjunctively with glaucoma treatment, to speed healing after cataract surgery, treat seasonal dry eye and even make contact lens wear possible for dry eye patients.

Plugs may be placed in 2 puncta or all 4, depending upon the treatment goal. Tear duct plugs help to manage dry eye disease by safely keeping valuable tears on the ocular surface, whether they are natural tears or tear substitutes.

Finding your ideal lacrimal plugs

Most eye doctors would agree that the ideal tear duct plug would be simple to insert for the physician, comfortable and easily retained (and therefore effective) for the patient–and would also require the least upkeep and aftercare by patient and medical staff.

This also means the plugs you choose for each patient (or rather, help each patient choose) must be as side effect-free, helpful and convenient as possible.

With the variety of patient types and eye conditions, you will typically need to stock a few different punctal plug types in your office, to properly accommodate every patient.

The Ophthalmologist’s guide to punctal occlusion devices

Lacrimal Plug Materials, Shapes and Designs for Specialized Functions

Tear duct plugs can be divided into several purpose-built types:

• Temporary lacrimal plugs, used diagnostically to determine patient benefit are typically made from collagen: for instance, the high quality EagleVision temporary collagen tear duct plugs.
• Extended duration punctal plugs are generally synthetic copolymer or silicone, such as the Duraplug long term temporary, a synthetic extended temporary plug for punctal or canalicular insertion, effective for 2 to 6 months.
• Flow control tear duct plugs are perforated to allow limited tear flow and avoid epiphora/overflow. For example: Dissolvable VisiPlug Lacrimal Plugs reduce tear drainage for 4 to 6 months or the Beaver-Visitec/Odyssey Micro Flow long term or permanent insert.
• Absorbable or dissolvable tear duct plugs for the convenience of patient and clinician, such as the Ultraplug Extended Wear Synthetic absorbable.

Other useful features include:

• Pre-loaded plugs packaged inside disposable cannula for quick insertion, available from multiple manufacturers, such as the recently FDA-approved VeraPlug punctal occlusion system for chronic dry eye.
• Tapered designs for easy insertion. Try the EagleVision silicone FlexPlug, with ribbed shaft (interior and exterior) for flexibility and staying power.

In a perfect world, you’d like each to fit patient who makes the decision to “get plugged” with lacrimal plugs that conform optimally to the puncta — fulfilling patient needs as well as the needs of the eye care professionals working in your practice.

By keeping a variety of your favorite punctum plugs in your medical office supply closet, you can put patient comfort first while avoiding issues such as allergic reaction, infection or plug migration.

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