What is Punctal Occlusion Surgery, Who is the Ideal Candidate & How is it Performed?

What is Punctal Occlusion Surgery?

Punctal occlusion surgery is one of the most innovative and advanced designs available today in ophthalmology. Punctal occlusion surgery is the most preferred treatment option for dry eyes. Dry eye disease is a common condition that is characterized by a range of signs and symptoms. The goal of punctal occlusion surgery is to minimize the drainage of the tears and to keep them in the eye for longer periods so that they can provide sufficient lubrication. Punctal occlusion surgery can be combined with other treatment methods to get the best results.

Who is the Ideal Candidate For Punctal Occlusion Surgery?

Dry eye disease is a common condition that is characterized by a range of signs and symptoms. The prevalence of this condition is between 5% and 30%. It may be caused by a number of factors like age, eyelid conditions, hormonal changes, systemic conditions, adverse environmental influences, and wearing contact lenses. Despite wide range of etiology, dry eye disease involves the inflammation of ocular surface and loss of homeostasis of the tear film. The water loss resulting from the evaporation causes tear hyperosmolarity (as osmolarity in your tears increases ocular surface cells become damaged) that leads to eye discomfort, tissue damage, and the inflammatory mediators that can be detected at the ocular surface and in the tears. Dry eyes must be treated because the symptoms do not go away on their own. Punctal occlusion surgery is one possible treatment that often must be combined with other treatments to solve the complex problem of dry eyes.

What is Punctal Occlusion?

Most of the tears are produced by lacrimal glands which are located behind the upper eyelids. A film of tears is formed with these tears. This film empties in the nose passing through the nasolacrimal duct on a regular basis. The lacrimal punctum is the entrance to this duct. It is a tiny opening present in the corner of eye. The inner portion of each eyelid has a lacrimal punctum. The function of these puncta is to collect tears that are produced by the lacrimal glands. The fluid then goes to the lacrimal sac through the lacrimal canaliculi. It then passes through the nasolacrimal duct to the nasal passage. When you have dry eye syndrome, there is some abnormality in the process through which tears are produced and adequate tear production does not take place.

These are problems which at times be addressed with a procedure called punctal occlusion. The main aim of a punctal occlusion is cut down the flow of tears from the eye and to allow accumulation of the tears to provide adequate lubrication.

Punctal occlusion is one of the most innovative and advanced designs available today.

What are Punctal Plugs?

Punctal Plug which is also known by the name of Lacrimal Plug is a device which is inserted into the tear duct to block it. This is done to prevent the drainage of tears from the eye. They are used to treat dry eye. They are very minute biocompatible devices and range from 0.3-0.7 mm in diameter. It is quite similar to a single grain of rice.

They are made up of materials like collagen, silicone, acrylic polymer, and hydrogel. The collagen plugs are temporary as they are dissolvable, lasting from a few days to a few months. The plugs are first used to determine whether the procedure will be beneficial for the patient. Silicone punctal plugs are used for more permanent, longer lasting occlusion. Following are the materials that are used for punctal plugs.

Material Details
Silicon They are permanent plugs
Collagen They are dissolvable/temporary plugs
Hydrophilic or acrylic polymer They are solid at room temperature but melt at body temperature
Hydrogel These hydrate on insertion, filling up the cavity

How is Punctal Occlusion Surgery Performed?

Punctal occlusion surgery may be performed in an examination room and not in a surgery center. After checking in the hospital, you will be made comfortable and eye drops will be used to topically anesthetize your eyes.

Inserting a plug is a simple non-surgical procedure. It is painless to the patient and it can be performed in a few minutes. To ensure a comfortable fit, the doctor selects the correct size of punctum plug for you. The plug may be put in both superior and inferior punctum, but is usually done with just the inferior. Later, the punctum is dilated for a smoother insertion of the punctum plug. The plugs are then put into the duct through forceps or a syringe like device called inserter. Both of the devices do not cause any pain to the patient.

The plugs come in variety of designs, some are visible and others are not as they are inserted deeper. The level of comfort provided is same for both and both can be removed if needed.

After insertion, once the plugs get wet, they expand to completely fill the opening. The entire Punctal occlusion surgery procedure takes only a few minutes. Many patients report immediate relief from dry eye symptoms and resume normal activities immediately after Punctal occlusion surgery.

The necessity for a plug to be removed is extremely rare. However, if the plu8g becomes an issue for the patient then it can be flushed out easily

Both insertion of the plug and its removal are extremely fast and do not cause any pain. There is no recovery period required after this procedure. The patient can carry on normal activities and drive without any problems immediately after the procedure.

Side Effects Of Punctal Occlusion Surgery

Serious complications with punctal occlusion surgery are extremely rare, but like any medical procedure, it does have some risks involved. You may experience some discomfort after having the plugs put in. Sometimes the plug may cause the patient watery eyes, in which condition the physician may take out the punctal plug, replacing it with another one.

Sometimes, the plugs may get displaced or the patient may lose it. It is common in people who have a habit or rubbing their eyes. This is seen commonly in hard plugs. In this case, the patient may go to the doctor to get a new one inserted again. Other than this, the patient can also develop canaliculitis or dacryocystitis. Be assured, if you experience any kind of side effects, your doctor can remove/replace the plugs.

Following are the conditions when it becomes necessary to remove or be replaced with another type of punctal plug:

  • If the patient feels very uncomfortable
  • If the patient develops infections like canaliculitis
  • If the patient develops dacryocystitis
  • If the patient gets excessive watery eyes.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:November 30, 2018

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