Dry eyes are a source of concern for millions of us on a daily basis. When “dry eye”, which leads to scratching and irritation, occurs many of us find relief from simple remedies, such as eye drops, or changes to environmental factors that may be causing the issue (smoking, additional humidification). There is a procedure, however, that is gaining attention as a way to provide relief, punctal plugs (small plugs placed in the corners of the eyes to reduce tear drainage).
For some, this may be a solution, but there are pros and cons to consider since it is an invasive therapy that includes risk.
Punctal plugs have both pros and cons. The pros are that they are a safe method to retain tears on the ocular surface and have value in relieving symptoms when tear production is borderline or if the duration of applied tear substitutes needs to be prolonged. They are helpful as adjunctive treatment in the management of dry eye disease.
The cons are that when applied in the presence of inflammation that can occur as part of dry eye disease, they may aggravate symptoms by allowing the inflamed tear to have prolonged contact with the surface of the eye. Therefore, my recommendation is to treat the underlying inflammation before placing the plugs. Another con is that they can fall out and need frequent replacement. Rarely, the plug can provoke a localized inflammatory reaction in the tissue of the eyelid and produce a granuloma at the opening of the tear drainage puncta.
On balance, punctal plugs are a useful adjunctive treatment for dry eye disease but should be used in conjunction with other therapies to control inflammation.
EyeSmart, a publication from the American Academy of Ophthamalogy, offers some information about other alternatives.
First of all, if you smoke, stop. Dry air can increase dry eye symptoms, so try using a humidifier to add moisture to the air in your home. Other simple solutions include placing warm, moist cotton pads or washcloths over the eyes and using artificial tears or lubricating eye drops.
There are other things you can do to ease dry eye symptoms. If you use a computer or other digital screen all day, you may not be blinking often enough to spread the normal tear film over your eye. Try taping a reminder note to the edge of your screen! Normal tear film production depends on your getting enough sleep, so you have one more good reason to go to bed on time. Avoid spending too much time in windy environments, and wear wrap-around style sunglasses to protect your eyes from the wind. These remedies will usually restore a person’s normal tear film and clear up dry eye. If the problem persists and makes good vision difficult, punctual plugs can be considered.
As always, use this information for a conversation with your doctor about the right choice for your specific needs in order to fully understand the risks and benefits.