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Punctal Occlusion

A Common Treatment for Dry Eye

By

Updated February 06, 2012

What Is Punctal Occlusion?

If you visit your eye doctor with complaints of dry eyes, you will likely be informed about "plugging your tear ducts." Punctal occlusion is a painless procedure in which the puncta (small openings in the corners of the eyes through which tears drain) are blocked. Blocking the puncta increases the amount of tears available to bathe the front part of the eye by decreasing the amount of tears that drain away from the eye. Instead of plugging the gland that produces tears, punctal occlusion plugs the tear drainage pipe. (Think of plugging the drain in the kitchen sink -- the faucet still runs.)

How Is It Done?

A collagen or silicone plug is inserted into the puncta to decrease or slow tear drainage. The puncta is a small opening located on the nasal part of the inner eyelid. Two puncta are on each eye, one on the upper lid and one on the lower lid. With each blink, the eyelid not only moves vertically, but it also makes a small horizontal motion, pushing the tears toward the nasal part of the eye and into the puncta. The puncta drains tears and debris into a small tissue canal and into the naso-lacrimal sac, then out through a small opening leading into the nose and throat. This process is noticeable when you cry, as your nose runs and your throat may become congested.

Why Does It Work?

By occluding the puncta, the tears stay in the eye longer, so your vision is clear and your eyes are comfortable. Your doctor may offer to perform punctal occlusion with temporary dissolvable implants that dissolve anywhere from 7 days to 3 months. Most commonly, a doctor will insert 7-day dissolvable implants and ask you to return to the office in 10 to 14 days. Depending on the severity of the condition, your dry eye symptoms should start to improve immediately. After about a week, your symptoms should return. Temporary punctal occlusion serves as a test for you and your eye doctor to see if permanent occlusion would be beneficial. Permanent punctal implants are usually made of silicone or another inert material that is biocompatible with our bodies. They do not dissolve, but can be removed if necessary.

Should You Try It?

Punctal occlusion is the next best option when artificial tears aren't enough to control the symptoms of dry eye. Punctal occlusion not only keeps more volume of tears in your eyes, but can also improve the overall dry eye condition. A dry eye patient often develops dry patches on the cornea and the conjunctiva. Tears then become unable to "stick" or bind to the eye’s surface. Punctal occlusion not only causes a larger volume of tears to stay in the eye, but also improves the health of the surface of the eye over time. This enables the dry patches to fade and the tears begin to properly coat the eye.

Source:

Lancaster, C. Steven, "Occlusion: Assess Your Options. Optometric Management, September 2005.

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