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Punctal Plugs and Lasik

Plugs to block the canals that drain tears are a common technique to resolve dry eye related to Lasik or Bladeless Lasik.


Illustrated diagram of the punctum canals inset into an image of an eye.  
Punctal plugs can help resolve Lasik induced temporary dry eye by restricting tears from draining into the sinus through the punctum.  
   

Punctal occlusion with punctal plugs is a method to block the intracanalicular punctum with temporary or permanent plugs. When properly fitted, punctal plugs are not felt by the patient or visible to others.

Common After Lasik

It is relatively common for conventional or wavefront custom Lasik, Bladeless Lasik patients to receive punctal plugs. Punctal plugs help keep the eyes hydrated by blocking the drainage of the tears through the nasolacrimal duct into the sinus system.

Punctal plugs come in many styles and sizes. A comfortable fit should be available for all.

Temporary or Permanent

A Lasik patient may be provided with temporary punctal plugs. After a predetermined number of days, they dissolve. If relief from dry eye symptoms is provided during those few days, then semi-permanent plugs may be inserted.

It is also possible to have these tear drainage ducts permanently occluded with cauterization, but that is useful primarily if the dry eye is chronic and expected to be long-term. The semi-permanent plugs are normally comfortable and successful, and Lasik-induced dry eye normally eventually resolves.

Headache Sinus Pain

Punctal plugs may help keep tears on the eye, but the sudden lack of moisture into the sinus can cause irritation that may present as headaches and pain behind the eye. See our article about Lasik eye strain. These symptoms are often initially attributed to dry eye. Verification if punctal plugs are required may be helpful. See also Lasik dry eye treatment.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

Personalized Answers

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.


Recent Punctal Occlusion Medical Journal Articles...

Related Articles

Impact of conjunctivochalasis on visual quality of life: a community population survey.

PLoS One. 2014;9(10):e110821

Authors: Le Q, Cui X, Xiang J, Ge L, Gong L, Xu J

Abstract
Conjunctivochalasis (Cch) is a very common ocular disorder, which can cause an unstable tear film and ocular discomfort. The study of vision-related quality of life (VR-QoL) in a community population with Cch can provide a better understanding of the impact of Cch on common people than objective clinical examinations alone. This cross-sectional comparative study enrolled 360 participants ≥40 years old living in Sanle Community, Shanghai. In the study, 198 subjects were diagnosed with Cch and 86 with dry eye syndrome (DES) without Cch. The remaining 76 subjects were normal controls. Socio-demographical data were collected, and Cch and related ocular symptoms and signs were evaluated. In addition, all participants were required to complete the Chinese version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and Ocular Surface Disease Index Questionnaire (OSDI). Main outcome measures include the comparison on the OSDI score and VFQ-25 score among the subgroups, and the correlation of these scores with the socio-demographical and clinical data. The results revealed that subjects with Cch had significantly decreased tear film stability even compared with those with DES (P = 0.001). The participants with either Cch or DES reported significantly higher OSDI scores and lower VFQ-25 composite scores than the normal controls (P<0.001 and 0.007 respectively). Further comparisons among the subgroups of Cch revealed that the following factors were associated with higher OSDI scores and lower VFQ-25 composite scores: nasal-side Cch, chalasis folds higher than tear meniscus height, punctal occlusion, or increased extent of chalasis on digital pressure. In conclusion, Cch was associated with an adverse impact on VR-QoL in a community population, and the impairment in VR-QoL had a significant correlation with disease severity and tear film abnormalities.

PMID: 25330252 [PubMed - in process]

 


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