Punctal Plugs
The use of punctal plugs can be an effective step in treating moderate to severe dry eye that is unresponsive to artificial tear drops and ointments. The tears drain into the nose via the tear ducts and blocking this outflow is a reasonable strategy to keep the tears in the eye for a longer time.
The term 'puncta' refers to the opening of the tear ducts on the eyelid margin. Plugs that can be inserted inside the tear ducts to block them are called 'punctal plugs'. Punctal plugs increase the comfort level and lower the frequency of artificial tear use in most dry eye patients. The decreased artificial tear use may be economically beneficial, considering the high cost of preservative-free artificial tears.

Punctal plugs can be inserted either in the lower eyelid or in the upper eyelid or in both eyelids. Temporary punctal occlusion with collagen implants may be considered to ascertain if the punctal blockage will help reduce dry eye symptoms and also to rule out excessive tearing due to such blockage. Most silicone punctal plugs are umbrella shaped and top part of the punctal plug rests on the eyelid surface. A different type of punctual plug (Herrick plug) is completely embedded within the tear ducts.

About 40% of punctual plugs are lost within 6 months of insertion. Most of the punctal plugs lost are due to spontaneous extrusion, and this happens usually within the initial 3 months post insertion. In addition, about 10% patients may complain of local discomfort at the plug site or excessive tearing (especially if both upper and lower puncta are blocked) and the punctual plug may have to be removed in these patients. This is a simple procedure and is painless. Patients who have lost the initial plug are twice as likely to lose the replacement plug. Upper punctal plugs have a higher risk of loss compared with plugs inserted in lower puncta. (Am J Ophthalmol 2001;131:30-6, Cornea 2002;21:135-9)
Video of temporary collagen punctal plug insertion.
Video of silicone punctal plug insertion. (video links to http://www.edinburgh-eyetests.co.uk)

A different type of punctal plug has been recently introduced. This punctal plug (marketed as SmartPLUG punctal plug by Medennium, Inc.) is made of a thermosensitive, hydrophobic acrylic polymer that changes from a rigid solid to a soft, cohesive gel when its temperature changes from room temperature to body temperature. Outside the punctum, at room temperature, the SmartPlug is a rigid rod. Forceps are used to insert the SmartPlug into the punctum. As the material inside the punctum rapidly warms, it shortens and expands in diameter, turning from a rigid rod into a gel-like plug, conforming to the size and shape of the punctum. Removal, if necessary, is accomplished with irrigation. Once inserted, no part of the SmartPLUG protrudes on the lid surface, therefore the potential to irritate or scratch the cornea may be less than the silicone plugs (which have a protruding cap).

Moisture Chambers
The basic idea behind moisture chambers is to enclose the eye so that evaporative loss of tears is prevented. Since approximately 25% tears are lost by way of evaporation, this strategy will preserve tears in the eye for a longer time by limiting evaporation. We list below the moisture chambers we are aware of, including contact information to order them.

  ● PanOptx Dry Eye / Windless Eyewear
PanOptx has designed these sunglasses to be fashionable enough to be worn in public, yet retain the function of a moisture chamber. PanOptx sunglasses create an orbital seal that protects against wind drafts, dust/pollen etc. and helps to conserve the eye moisture.
  ● NitEye Dry Eye Comforter
  ● MoistEye Moisture Panel
  ● Moisture Chamber Occluder
  ● Swimming Goggles

Moisturizing Mist & Humidifers
Nature's Tears is an all-natural moisturizing mist for the eyes made of tissue-culture grade, pH correct water. By spraying the mist on the face, the tear film is claimed to replenish.
Commercially available humidifiers may be used to increase the overall humidity level in the enviornment, especially in the dry winter months when indoor heating exacerbates dry eye symptoms.

Contact Us Complete the form below to contact us. If you would like a reply, please include your name and email address.