A technique for preventing spontaneous loss of lacrimal punctal plugs

A Simple Step-by-Step Guide to Permanent Punctal Occlusion with the Ophthalmic Burr and Suture Technique

The medical treatment of dry eye disease usually follows a step-wise approach to achieve clinical improvement, ranging from non-surgical interventions with intensive lubrication to permanent surgical punctal occlusion. While frequent lubrication is essential, the intense regime is often too burdensome and difficult to maintain at the required frequency. Punctal plugs are an invaluable alternative approach, but also have limitations, especially in conscious children, in whom inserting and re-inserting punctum plugs in clinic can be challenging. If a patient has permanent and severe dry eye disease and responded well to a trial of temporary punctal plugging, a permanent surgical solution should be considered next. Liu et al showed that a more successful, yet simple technique to achieve permanent occlusion is to combine de-epithelialising the punctum and ampulla with the immediate firm apposition of the de-epithelialised surface using a self-absorbable suture - with a success rate of 92% in a prospective study. This article demonstrates this technique step-by-step in an 8-year-old child with severe chronic dry eye disease following proton beam therapy for orbital rhabdomyosarcoma. She underwent this procedure with excellent results.

Comprehensive Review of the Literature on Existing Punctal Plugs for the Management of Dry Eye Disease

Numerous designs of punctal and canalicular plugs are available on the market. This variety presents challenges to ophthalmologists when choosing punctal plugs for the management of various ocular conditions. The aim of this literature review is to provide a classification system for lacrimal occlusive devices based on their location and duration of action as well as to identify different characteristics of each one of them. We want to give a comprehensive overview on punctal and canalicular plugs including their manufacturing companies, indications, and complications that have been reported in various articles. PubMed and Google Scholar were used to identify articles written in English as well as few articles written in Japanese, Chinese, Slovak, and Spanish that had abstracts in English. Nine different companies that manufacture punctal and canalicular plugs were identified and their plugs were included in this review. Punctal and canalicular plugs are used in the management of various ocular conditions including dry eye disease and punctal stenosis as well as in ocular drug delivery. Although they are a relatively safe option, associated complications have been reported in the literature such as infection, allergic reaction, extrusion, and migration.

A review of the complications of lacrimal occlusion with punctal and canalicular plugs

Punctal and canalicular plugs are widely used for both temporary and permanent occlusion of the lacrimal puncta in dry eyes. There are many designs and materials available on the market. While their efficacy in improving dry eye symptoms is widely proven, the gamut of complications associated with these devices have never been subject to a general review, although there are numerous case series in the literature associated with one particular device. This review aims to examine the track record of a variety of plugs currently in use, to review the management of complications, and propose strategies for both the prevention of these complications and their treatment.