Punctal plugs, also known as punctum plugs, lacrimal plugs, or occluders, are a method of treating dry eyes. Punctal plugs can relieve dry eye symptoms when eye drops or ointments fail. Punctal plugs are placed in the opening of the tear duct, reducing the natural drainage of tears and keeping the eyes moist. Punctal plugs can be a temporary or permanent solution to dry eyes.
Typically, a temporary or dissolvable punctal plug is implanted in the lower drainage channel of the eye, which is responsible for most of the eye's tear drainage. These temporary plugs will usually last a few days to several months. If there is a successful response to the temporary punctal plug, a more permanent punctal plug is implanted or punctual cautery applied.
Punctal plugs come in a few different shapes and sizes, and are no larger than a grain of rice. The plug may be placed in the lower or upper eyelid or both eyelids. Implantation takes only a few seconds in a physician's office.
Tear Duct Probing, irrigation, intubation
A nasolacrimal duct obstruction, more commonly known as a tear duct obstruction, is a common condition that affects infants and is present at birth. Tears usually drain through small openings in the corners of the eyelids, known as puncta, and enter the nose through the nasolacrimal duct. When an obstruction exists, tears cannot properly drain from the eyes and may well up on the surface of the eye and overflow on the eyelashes and eyelids. The eyelids may also become red and swollen with yellow or green discharge. This pathology in children is usually different than that in adults.
While most cases of tear duct obstructions clear on their own during the first year of life, certain measures can be taken to ensure that the eye is kept clean and free of infection, such as a tear duct massage performed three times a day or antibiotic eye drops to relieve discharge. If an obstruction does not clear up by the time the child is a year old, a minimally invasive procedure using a probe to relieve the obstruction may be used. This procedure involves passing a soft probe through the tear duct and into the nose to open any obstruction within the path. The procedure takes about 10 minutes to perform.
Adults may also benefit from the probing procedure, however some cases may need to be treated with surgery to clear the obstruction of the duct.
If tear blockage cannot be effectively treated through conservative methods, surgery will likely be recommended. A procedure known as dacryocystorhynostomy or dacryocystorhinostomy (DCR) will be performed to construct a new tear drain. This type of surgery is usually performed as an outpatient procedure, either using local anesthesia and sedation or general anesthesia. Given the difference in cause, this is usually the treatment for tear duct obstruction in adults, as opposed to the probing and irrigation noted above for children.
With the traditional external form of this surgery, the doctor would make an incision on the side of the nose and create an opening between the tear drainage system and the nose. With the endoscopic approach, this procedure is formed without the skin incision. The surgeon uses an endoscope -a thin, flexible, lighted tube with a microscopic camera on the end. The camera helps the doctor guide other tiny instruments used in the procedure, through the nasal opening to access the tear duct area this way.
A new tear drain opening is then created, providing a fresh route between the eyes and nose avoiding the obstruction. A tiny stent (silicone tube) may be placed in the new tear drain and kept there for several months after the procedure ensuring the duct will remain open. In cases in which the tear drain blockage cannot be cleared, a small drain, known as a Jones tube, may need to be inserted in the area. This offers a permanent solution to keeping the tear duct clear.