What factors should I consider in deciding whether Punctal Plugs are the right treatment for my dry eyes after LASIK?

Doctor's Answers (1)

Punctal plugs are very effective for treating dry eyes that occur during waking hours, whether or not the situation is associated with LASIK. They help to reduce the need for eyedrops, so are very useful for people who have to use artificial tears very frequently eg instead of having to use the eyedrops every 2-3 hourly, sometimes after the plugs are placed, the eyedrops might only be needed every 4-6 hourly. As long as there is no active eye inflammation (eg persistent eye redness/discharge), punctal plugs can help anyone with moderate dry eyes requiring frequent eyedrop instillation.

The effectiveness of punctal plugging can vary from person to person, but can be maximised by plugging all 4 of the drainage channels on both sides.

There are 2 main types of punctal plugs-temporary dissolvable plugs and permanent silicone plugs. I almost never use silicone plugs nowadays because they sometimes collect mucus and debris around them (part of the plug protrudes onto the surface of the eyelid) and they often fall out by themselves. The temporary dissolvable plugs are inserted into the tear channels and block them for a period ranging from about 3-5 months, and then disappear by themselves.

The fact that they dissolve away minimises the risk of infection, but also means that the dryness may return once they have dissolved away. In such cases, I offer patients a more permanent solution, which is called ‘punctal cautery’. This uses a special heated probe to permanently shrink and close off the tear drainage channels, and is usually only offered for people who have used the punctal plugs before and found them to be helpful.

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