My Experience with Punctal Plugs

If nothing else, my punctal plug story is entertaining. Hopefully, you will find it informative as well if you are considering having the procedure.

Inserting punctal plugs

These tiny inserts, placed in the openings to the tear ducts, are a long-used treatment for dry eyes, as they are low-maintenance and not very invasive. They can be helpful if the patient is a good candidate. Inserting punctal plugs was the first step my local eye doctor tried on me.

To begin, he used dissolvable collagen plugs in my lower puncta, hoping to hold tears on the surface of my eye and prevent them from draining off as quickly. The procedure was painless. The doctor used some tiny forceps, and the plugs were so small that I barely even felt them being inserted.

He said that they would last a week or two, and he suggested I come back in a couple of weeks for a check-up. If the plugs were working, he could insert a more permanent solution.

Another procedure

At this point, I really couldn’t tell if these dissolvable plugs helped or not, because I had so many other issues. But I decided to go back and try a more permanent option. Here’s where the story gets interesting. I had the semi-permanent silicone plugs inserted; they have a little mushroom tip that sticks out of the punctum so that they can be easily removed.

The doctor went with a medium size plug, and he had some trouble getting it into my right eye. This procedure was a little more uncomfortable than my first. It didn’t really hurt, but it made me anxious because I felt like the doctor was digging down into the corner of my eye.

Passing out at the doctor's office

I sometimes have a vasovagal response when having blood drawn, and I pass out. I had the same uncontrollable response here. My blood pressure dropped, and I could feel the response coming on after the procedure. The last thing I remember was telling the doctor’s assistant that I felt really hot and that I needed to lay down. Then, I passed out! (Most people don’t have this response, but I have read that it does sometimes happen.)

When I woke up, I was reclined in my chair, and people were fanning me and holding a cool compress on my head. I had to call my husband to come pick me up. I never imagined that I would pass out at the eye doctor! I left that day feeling weak but hopeful that the plugs would help. They didn’t because, again, I had so many other issues.

Seeing a specialist

When I finally saw a dry eye specialist, he was a little concerned over my punctal plugs. He said that sometimes they can make things worse by holding inflamed tears on the eye. He usually only inserts them after inflammation is under control, and I had a lot of inflammation.

But he feared removing them because the puncta could be stretched out, causing my tears to drain off too quickly and making my situation worse. He said that we may eventually need to take them out, but that we would leave them in place at that visit. He decided on some alternative treatments, a steroid drop called Flarex and then Xiidra.

The sensation of something in my eye

I saw a big improvement after starting Xiidra, but I still had a great deal of discomfort.

As my eyes were improving with the help of this drop, they were also getting worse, in a sense, because of the plugs. I felt like the tips of the plugs were scratching my eyes. As I blinked all day long, my eyes became more and more irritated in the inside corners. And I couldn’t shake the sensation that something was in my eye.

Having my plugs removed

My husband had just started seeing a new local eye doctor and was pleased with his thorough level of care. Traveling four hours to see my specialist was difficult, so I made an appointment with this doctor.

He removed my plugs after doing epithelial staining to detect abrasions due to the plugs. (I was nervous about having them removed after what happened when I had them inserted, but they came out with little trouble). After, my eyes were significantly dryer for about three days but eventually leveled out.

My specialist says that plugs are still an option now that the inflammation in my eyes is under control. He usually inserts dissolvable ones that last about six months. These do not stick up out of the punctum and cause scratching issues.

For now, we are trying some other options, but even with all of my past trouble, I would still consider having these other plugs inserted in the future if they might be helpful.