Punctal Plug Insertion
Dry eye syndrome is treated with a step-wise approach. When medical therapy, including artificial tears and cyclosporine (e.g. Restasis) is not enough, blocking the exit of tears from the surface of the eye may be helpful. This can be accomplished with temporary dissolvable plugs or more permanent punctal plugs. Dissolvable plugs are occasionally used to test whether closing the tear ducts will be beneficial. More commonly, silicone plastic plugs are placed. These generally remain in the tear ducts for months, or ideally, years. They are placed in an in-office procedure that typically takes a few minutes. The main downside to plugs is that they occasionally fall out. While this doesn’t cause any problems, when they fall out they aren’t working anymore. They can generally be replaced with a larger plug. When the largest plugs fall out, punctal cautery can be considered (see below).