Punctal Plug Procedure for Severe Dry Eye:
What Exactly Is It?

Hello! This is BGN Eye Clinic at Jamsil Lotte World Tower. Some of you might have already met me during your outpatient visits! Today, I found myself constantly running back and forth in the clinic, hearing our staff call out, "Doctor, the next patient is ready!" more times than I can count.

Among all the patients I saw today, there was one particular individual who stayed on my mind long after the clinic closed. It was a patient visiting for their first follow-up checkup after undergoing SMILE Lasik surgery. They mentioned that their eyes felt quite dry and somewhat gritty.

When the doctor suggested performing a quick "punctal plug procedure" to alleviate the discomfort, the patient’s eyes widened with surprise as they asked, "A plug procedure? What exactly is that?"

What Is a Punctal Plug Procedure?

During post-operative follow-ups, we often hear patients say, "My eyes feel incredibly dry," or "Even when I apply artificial tears, they dry up almost instantly." While temporary dryness immediately following surgery is common for everyone, those who already suffered from pre-existing dry eye syndrome tend to experience more pronounced symptoms.

The patient I met today was constantly blinking throughout our conversation, and their hands instinctively kept moving toward their eyes. It was clear that the patient was experiencing significant discomfort that went well beyond mild dryness. They mentioned they had a history of severe chronic dry eyes.

Following a thorough examination, the doctor noted that the patient's tear film was evaporating far too quickly, leaving the ocular surface unstable and causing heightened dryness and irritation. To address this, the doctor recommended inserting tiny plugs into the tear ducts to allow natural tears to remain on the surface of the eye for a longer duration.

Tiny Rods that Block the Tear Ducts: Punctal Plugs

A punctal plug refers to a small collagen-based device that is inserted into the tear duct (lacrimal canaliculus) to block tear drainage. Normally, tears are produced in the eye and then flow out through the tear drainage system (tear ducts). However, if this drainage happens too quickly immediately after surgery, the eyes can feel stinging, dry, and gritty.

In such cases, gently blocking the drainage pathway with a punctal plug helps tears stay on the eye longer, maintaining moisture for an extended period. Think of it as a helpful supportive device designed to retain your natural moisture instead of letting it slip away! This procedure is typically utilized shortly after surgery when severe dryness begins to interfere with the healing process.

Key Characteristics of Punctal Plugs:• Size: Microscopic rods measuring roughly 2mm, designed to fit perfectly into the tear puncta.
• Material: Typically made of collagen or silicone (materials may vary by clinical indication).
• Duration: Collagen plugs generally maintain their effect for 1 to 2 weeks before dissolving naturally.
• Insertion Site: Primarily inserted into the lower puncta of the eyelids.

(Note: The exact material and duration tailored to your eyes will be detailed during your consultation.)

Is the Procedure Recommended for Everyone?

Occasionally, patients ask, "I heard other people get them, can I get them too?" However, punctal plugs are not a universal solution for everyone! Because this treatment involves physically blocking a natural drainage pathway, our surgeons must carefully evaluate your tear film stability, tear volume, and overall recovery rate before deciding.

We typically recommend punctal plugs under the following circumstances:

• When severe dryness and stiffness persist after SMILE Lasik or conventional Lasik.
• When frequent application of artificial tears provides no noticeable relief.
• When advanced ocular surface testing shows rapid tear film evaporation or low tear production.
• When chronic dry eye symptoms worsen significantly after contact lens use.

While almost everyone experiences some degree of dryness in the early stages of post-operative recovery, most heal naturally over time. Punctal plugs are a selective treatment option used only when the doctor determines that artificial tears alone are insufficient. It is a precise remedy offered only after a meticulous examination of your eye health.

Does the Treatment Hurt?

The punctal plug procedure is very simple. Patients only need to keep their eyes slightly open while a small plug is gently inserted into the lower tear duct to slow down tear drainage. The insertion takes less than 10 seconds per eye, and there is virtually no pain involved.

The only minor challenge is that keeping the eyes open can be difficult for many patients! It is completely natural to reflexively blink or tense up when a hand approaches your face. To help with this, our dedicated clinical care team always gently stabilizes the patient's head and provides warm, reassuring guidance throughout the process.

"Keep your eyes open just a little bit, it will be over in a flash!"
"Just a few more seconds! You are doing absolutely wonderful!"

At times, we support the patient's head with our hands and gently dab away tears to complete the insertion. Because we know this tiny device provides immense relief to those battling severe dry eye, our team does everything possible to ensure a smooth, successful experience.

Regular Follow-up Visits are Vital After SMILE Lasik

If there is one phrase our clinical team repeats multiple times a day, it is definitely, "Please keep your eyes open!" We know that if a patient blinks frequently, the insertion process can take longer, which is why we guide you with gentle yet firm instructions until it is successfully completed.

After surgery, it is very important to regularly attend follow-up outpatient visits to monitor the condition of your eyes. Occasionally, some patients skip their follow-up visits once the surgery is complete, but this is a definite no! Coming in for your scheduled appointments is the only way we can evaluate your recovery and provide timely, personalized care.

Please do not hesitate to tell us if you feel nervous or scared. Knowing your comfort level allows us to adjust and guide you through the process with extra care. There is nothing more rewarding for our team than when a patient who was deeply worried about the procedure smiles afterwards and says, "Oh? Is it over already?" We look forward to continuing to share helpful insights for your lifelong vision health.

Do not simply endure post-operative dryness. Receive a precise, comprehensive diagnostic evaluation today.