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A punctal plug, also known as tear duct plug or lacrimal plug, is a small medical device that is inserted into the tear duct (puncta) of an eye to block the duct. This prevents the drainage of liquid from the eye. They are used to treat dry eye. Artificial tears are usually still required after punctal plug insertion. [1]
A punctal plug may be inserted into the tear duct by an optometrist or ophthalmologist, decreasing the removal of natural tears from the affected eye. [8] The use of contact lenses may help prevent the abrasion during blinking lifting off the surface layer and uses thin lenses that are gas permeable to minimise reduced oxygenation.
Punctal plugs are thought to be "relatively safe", however, their use may result in epiphora (watery eyes), and more rarely, serious infection and swelling of the tear sac where the tears drain. [60] They are reserved for people with moderate or severe dry eye when other medical treatment has not been adequate.
Around 6% of infants have congenital nasolacrimal duct obstruction, or dacryostenosis, usually experiencing a persistent watery eye even when not crying. If a secondary infection occurs (dacryocystitis), purulent (yellow / green) discharge may be present. Most cases resolve spontaneously, with antibiotics reserved only if conjunctivitis occurs.
The lacrimal punctum (pl.: puncta) or lacrimal point is a minute opening on the summits of the lacrimal papillae, seen on the margins of the eyelids at the lateral extremity of the lacrimal lake. There are two lacrimal puncta in the medial (inside) portion of each eyelid. Normally, the puncta dip into the lacrimal lake.
Punctal plugs may be used to increase the amount of lubrication on the surface of the eyeball by blocking some of the tear-drainage ducts. Eye drops may also be used to provide additional lubrication or to stimulate the eyes to increase tear production.
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Causes of epiphora are any that cause either overproduction of tears or decreased drainage of tears, resulting in tearing onto the cheek. [2] This can be due to ocular irritation and inflammation (including trichiasis and entropion) or an obstructed tear outflow tract, which is divided according to its anatomical location (i.e., ectropion, punctal, canalicular or nasolacrimal duct obstruction).