Punctal plugs are a very effective treatment for dry eyes, when other treatments have been less than effective. Dry eyes can be more than a minor inconvenience for patients. It can be very painful.
Punctal plugs are not generally a first line treatment for dry eyes. Your eye care professional will need to make a definitive diagnosis first. Then other treatments may be tried to evaluate your response.
If these other treatments aren’t giving you the relief you need, you may be a candidate for punctual plugs. Here is how they work. Your eyes have lacrimal glands that produce the liquid or “tears” that bath the eye. Tears keep the eyes moist and help rid the eye of small particles of dust, dirt and pollutants.
These tears normally exit the eye through the tear ducts that are located in the upper and lower lids of the eyes at the bridge of the nose. You can see the puncta or openings on the inside of the lids. A small portion of tears are lost to evaporation also.
Punctal plugs are placed in these tear duct openings to keep the tears in the eyes. This dramatically decreases the amount of tears lost due to drainage. Increasing the amount of tears in the eyes and thus the lubrication will make the eye feel better.
Punctal plug insertion generally involves two different insertion procedures. The first insertion will be temporary plugs. This temporary plug will allow your doctor to evaluate how well this procedure is going to work for you. Occasionally, patients will have excessive tearing of the eyes when the puncta are plugged.
These temporary plugs will generally last 10 days to a few months. This is enough time for both you and your doctor to evaluate the effectiveness of punctal plugs for you. Punctal plugs are easily inserted and can easily be removed if necessary in your doctor’s office.
Your eye will first be numbed with an eye drop. Then the punctal plug will gently be inserted in the puncta using a sterile instrument. The procedure takes about a minute to perform. Your doctor will discuss with you prior to the procedure which type of plugs will be inserted. Upper and lower tear ducts can be plugged in this manner. Your doctor may elect to do just the lower ducts, or all four may be plugged.
Patients generally have no discomfort with this procedure and tolerate the plugs well. Plugs are tiny and not visible to others. Although the plugs are designed to be permanent, plugs do come out on occasion. Your Los Angeles eye doctor can insert another plug if this happens.
If you are bothered by dry eyes, be sure to discuss punctal plugs with your eye care professional. If your Los Angeles eye doctor does not put them in, a referral can be made to an eye care professional that places punctal plugs. Comfort can be one small procedure away.
Treatment of dry eyes in Los Angles is basically the same, regardless of which Los Angeles Eye Doctor you visit. Treatment will range from things as simple as eye drops, to a slight proceduresto correct the problem. As we discuss these options, though, it is important for you to realize that you need the counsel of a dry eye optometrist, prior to undergoing any treatment for your dry eyes.
Artificial tear drops and ointments. The first plan of attack would be to use some tear drops for your eyes. This is an over the counter remedy. This is a safe and effective way to keep the eye lubricated. If you suffer from chronic dry eyes, then you will be using these a lot. Even when you are not experiencing the symptoms of dry eyes, you will keep those symptoms under control with a product like artificial tears for the eyes. Ointments can also be used to help keep the eyes moist during periods of rest, when you are not necessarily “up and at it” to be putting tears in your eyes. The type and amount of lubricating drops should be discussed with your eye doctor after an appropriate dry eye work up is performed.
Temporary punctal occlusion. Another effective treatment involves temporarily closing off the ducts that drain tears from your eyes. A more permanent solution is possible, but this temporary solution is always used first, to see if plugging the duct can help keep enough moisture in the eyes to solve the dry eyes problem. The temporary plug dissolves in a couple of days. It will involve a couple of visits to your Los Angeles eye doctor.
Permanent punctal occlusion. As we have already mentioned, a permanent plug can be inserted in the tear duct. But this is only done after trying a temporary plug out. Patients typically do well with the plug, and do well over time. On occasion, the plug can come out. On great occasion, the plugs will migrate down the duct as well. These conditions would obviously need to be treated by a Los Angeles Optometrist. The plugs are typically made of silicon, and can be quite comfortable. This treatment can really help reduce the need for ongoing artificial tear therapy.
Restasis. In 2002, the FDA approved the prescription eye drop Restasis for the treatment of chronic dry eye. It is currently the only prescription eye drop that helps your eyes increase their own tear production with continued use. I have included a link for you to use to get more information on Restasis. Other medications, like topical steroids, can also be used in some instances.
Surgery. If needed, the ducts that drain tears can be closed for good. This surgical procedure allows more tears to remain around the eye. This is done with local anesthetic on an outpatient basis. There are no limitations in activity after having this surgery. Patients typically have a very quick recovery also. This is a kind of last step procedure for chronic dry eyes.
Well, there you have it. We have reviewed the treatment of dry eyes in Los Angeles, and given you some options. If you still have more questions, I invite you to contact me at Melamed Eye Care. We are always glad to help.
Fouad Melamed O.D.
