Punctal plug

Several topically applied local anesthetics are routinely used by the eye care specialist in certain routine diagnostic procedures and for various relatively simple surgical procedures such as insertion of punctal plugs and surgical vision correction. The first of these to be used was cocaine, in concentrations ranging from 1 to 4% [30]. More modern local anesthetics, however, such as tetracaine hydrochloride and proparacaine hydrochloride, have replaced cocaine as drugs of choice in these procedures. For surgical procedures of a more complex nature, lidocaine hydrochloride and similar local anesthetics as retrobulbar injections have been used [31]. 

Linden and Aim [8] studied the effect of reduced tear drainage on the intraocular penetration of topically applied fluorescein in healthy volunteers. In one eye of each participant both the lower and upper puncta were occluded by the insertion of punctal plugs. A single dose of 20 pL of a 2% solution of sodium fluorescein was instilled in the lower conjunctival sac of both eyes. There was a significant increase in aqueous fluorescein concentrations 1 to 8 h after application of fluorescein in the eye with the occluded puncta, to levels almost four times higher than in the other eye. 

Cyclosporine A (CsA, Restasis 0.05%) was approved in 2002 by the FDA as an ocular therapeutic for patients with keratoconjunctivitis sicca (dry eye). Until 2002 the therapy of choice for the treatment of dry eye was artificial tears and punctal plugs and the occasional use of pulse doses of topical steroids.Artificial tears and pimctal plugs brought some temporary relief to patients, but the underlying cause of dry eye, inflammation, was not affected. Steroids carried the threat of a multitude of side effects. With as many as 7.1 million people in the United States alone encountering dry eye symptoms, the development of a therapy that eliminates the inflammatory events associated with the disease has been a significant benefit. 

Figure 14-6 Inserted punctal plug. (Courtesy Leo Semes.)...

Ereeman JM. Punctal plug evaluation of a new treatment for dry eyes. Trans Am Acad Ophthalmol Otolaryngol 1975 79 874-879. 

Corneal debridement Punctal plug insertion Subconjunctival injection Superficial foreign body removal Suture barb removal... 

Lacrimedics, punctal plugs reversible diameter may be preloaded protrudes from the punctum,... 

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