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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...

Prospective Evaluation of Hypromellose 2% for Punctal Occlusion in Patients With Dry Eye.

Cornea. 2014 Dec 15;

Authors: Capita L, Chalita MR, Dos Santos-Neto LL

PURPOSE:: The aim of this study was to evaluate the effectiveness of punctal occlusion using hypromellose 2% in patients with dry eye.
METHODS:: In this prospective, randomized single-blinded clinical trial, we evaluated 76 eyes of 38 patients (36 women and 2 men) with dry eye secondary to rheumatic diseases. In each patient, the lower lacrimal punctum of 1 eye was occluded using hypromellose 2%, whereas the contralateral eye underwent a simulation of the procedure (control group). Patients' eyes were assessed for burning, itching, redness, foreign body sensation, and tearing based on a visual scale questionnaire (score, 0-10). We also performed objective tests for evaluation of dry eye using a Schirmer test with anesthesia (basal tear secretion test), the tear film break-up time test, and fluorescein and rose bengal staining tests at 0, 28, and 56 days after treatment.
RESULTS:: Fluorescein and rose bengal staining tests showed that there was a significant reduction in signs after occlusion using hypromellose. The symptoms measured by the visual scale were significantly reduced. The values of the Schirmer test with anesthesia and the break-up time test increased significantly. The effects persisted for up to 8 weeks. There were no dropouts or reported side effects during the 24-month follow-up.
CONCLUSIONS:: Our results suggest that punctal occlusion using hypromellose 2% is a low-cost and safe additional treatment for dry eye.

PMID: 25514700 [PubMed - as supplied by publisher]


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