what tear film layer does punctal plugs help maintain
aqueous layer
what is a collagen punctal plug used for
diagnostic tool: if pts symptoms improve w/ plugs, there is an aqueous component to dry eye
-temporary, lasts days or 4-6 wks
prognostic: trial to permanent plugs to be sure pt won’t suffer from epiphora (excessive watering)
what are the 2 different designs of the silicone plug
how can you remove each
- punctal occlusion design: intended to block tear drainage completely
- removed w/ forceps - intracanalicular design: titrate tear flow outward
- removed by irrigation through cnaliculus into lacrimal system
what are the differences to silicon plug insertion and collagen plug insertion
silicone: insert plug into vertical canaliculus w/ a slight rotating motion
what are the advantages and disadvantages of the intracanalicular design
advantage: unlikely to fall out, better comfort
disadvantage: unable to visualize if the plug completely passes the system at any time, must rely on symptom changes, unable to remove w/ forceps, use irrigation
what are the contraindications to punctal plugs
- do not perform during active dacryocystitis
- avoid use in patients w/ chronic eye infection
- do not use for patients w/ silicone hypersensitivty
