How to combat Dry Eye with Tear Duct Plugs
Dry eye is an ocular ailment frequently found among older people, contact lens users, and persons whose tear film quality is damaged by drugs or extraneous factors. Mechanical treatments are often used in the event dry eye symptoms cannot be relieved by eye drops and specially formulatedointments.
The next approach to treatment is usually the technique of obstructing the tear duct opening (also called the ‘punctum’) with specially crafted tear duct plugs, or punctal plugs. Each eye has two puncta, situated on the upper and lower eyelid corners near the nose. Tears usually are secreted from the tear glands and exit into the nose through the tear ducts.
Punctal plugs serve to constrain or even totally plug the outflow of tears from the eyes. By blocking this outflow, the eye can have tears remain on its surface longer. This keeps tear volume adequate in the eye, helping eliminate dry eye symptoms and lengthen the stay of externally-applied artificial tears. The closure of the tear drainage channel is called punctal occlusion (blockage) in medicine, and it may be temporary or permanent.
Temporary tear duct mouth occlusion refers to the method where the blocking procedure can be reversed and the plugs can be pulled out, when necessary. Temporary closure implies installing absorbable tear duct plugs (e.g. made from collagen, gelatine, and catgut) or plugs that cannot be absorbed (e.g. made from silicone, Teflon, etc.) Temporary closure is tested as an interim measure, to test if impeding tear flow in the tear ducts will relieve dry eye symptoms and also to see if the blockage will result in profuse accumulation of tears in the eyes. At the start, plugs are applied to all four puncta. If the blockage induces excess tearing, the upper plugs are removed and, after another week, the lower plugs are also pulled out if indicated.
Punctal plugs come in two styles. The first plug mode totally impedes tear flow and it is located at the opening of the tear duct. The second plug type is intended to moderate the rate of tear outflow and is usually implanted into the tear duct channel.
Tear duct plugs for temporary use are available in several diameter-sizes, normally ranging from 0.2mm up to 2.8mm. Plugs installed into the tear duct channels come in the smaller diameters. The usual absorbable plugs can last from several days up to two weeks, which gives enough time for observation on their effects. There are more durable kinds made of synthetic but still absorbable material, which can last 2-6 months.
Some people refer to occlusions using non-dissolvable tear duct plugs as semi-permanent occlusions, but the plugs are still removable. Permanent closures are another matter. They are not reversible because the tear ducts are permanently sealed by cauterisation (‘burning’) with a battery-operated or electric heat-producing device or laser photocoagulation (‘welding’). Laser cauterisation offers an advantage in that it can be employed to make just enough burns (or weld spots) to minimise tear flow without totally blocking the tear duct. However, experience has shown that non-laser cauterisation is more effective in the long-term. Tear ducts may be occluded permanently employing surgical methods. Regardless of the means utilised for permanent occlusion, the underlying principle is the creation of permanent and complete scarring into the tear drainage system to block tear outflow.
Permanent blockage is conducted only when it becomes certain that sealing the tear ducts will eliminate dry eye symptoms and will not induce too much tears. Permanent closure has an advantage over tear duct plugs. Tear duct plugs often come off without warning, and the chances of plug loss increases with each subsequent replacement. This risk is removed with permanent occlusion.
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