Punctal occlusion (68761, Closure of lacrimal punctum) is covered by Medicare and most major insurance companies when medically necessary.
; each by plug). Supportive documentation in the patient’s medical record is necessary as a surgical procedure.
How much does it cost to get punctal plugs?
- Out-of-pocket payments for consumers with health insurance often include copays for doctor visits, prescription drug copays, or coinsurance of 10% to 50%. Dry eye treatment is usually covered by insurance.
- In moderate situations, the doctor may advise the patient to use moist warm compresses and fake tears at home, as well as drink more water.
- The doctor may give a lubricant like FreshKote, a lubrication-releasing eye insert like Lacrisert, or an anti-inflammatory eye drug like Restasis to boost tear production in moderate to severe cases.
- Alternatively, the doctor may propose punctal plugs, which are inserted during a brief office procedure requiring just local or no anesthetic.
- Sunglasses and other dry eye eyewear can help protect and retain moisture in the eyes. These can cost anything from $15 to $150 or more.
- The US Department of Health and Human Services maintains a database of clinics that offer sliding-scale discounts based on income.
- Some pharmaceutical companies have patient assistance programs. Patients who don’t have prescription drug coverage and aren’t eligible for Medicare are usually eligible for Together Rx Access, a discount card that saves them 25% to 40% on numerous brand-name prescriptions. Most companies also provide free medications to patients who are uninsured and meet specific requirements. Restasis’ manufacturers are offering a $20 rebate that can be applied to your next prescription.
- An ophthalmologist finder is available from the American Academy of Ophthalmology. A guide on how to choose an eye doctor is available on WebMD.
Are punctal plugs worth it?
Punctal plugs alleviate symptoms of moderate dry eye that don’t react to topical lubrication, according to a 2015 report by the American Academy of Ophthalmology. In addition, the survey found that significant problems are uncommon.
If you have any issues with your plugs, contact your doctor right away. It is critical to treat infections as soon as possible. If necessary, the plugs can be safely removed.
Can an optometrist insert punctal plugs?
Punctal plugs are put at your eye doctor’s office during a short, painless, and in-office procedure. Punctal plugs can normally be inserted the same day if you and your optometrist agree on them as a treatment option. The initial step may involve measuring the size of your punctum to determine the right plug size. While you sit in the exam chair, your doctor will use tweezers and a lit microscope to precisely place the plugs into the punctum. The procedure is painless and rapid, typically taking less than one minute each eye. The insertion of punctal plugs carries very few risks. An allergic reaction to the plug is the most prevalent side effect, in which case the implant can be promptly removed or flushed out. The gadget is invisible once it is implanted and should not cause irritation or consciousness. Daily activities can be resumed right away, and most people experience a difference in their dry eye symptoms within the first several days. Your doctor will most likely want you to return for a follow-up visit to confirm the plugs are correctly put and working, but this is a very low-maintenance and successful treatment option for dry eye syndrome.
Can punctal plugs make dry eye worse?
For decades, nondissolvable punctal plugs, which are put at the ostium of the punctum with the tip exposed, have been a mainstay of aqueous-deficient dry eye therapy. When compared to lubricants alone, plugs improve ocular comfort, minimize the requirement for topical lubricants, and improve crucial dye staining. Punctal plugs are clinically effective in roughly 75% of cases. 1-4
Epiphora, corneal and conjunctival abrasion, extrusion, spontaneous loss, biofilm-associated conjunctivitis, granuloma formation, intracanalicular migration, and punctal imprisonment are all described consequences of plug use. All of these are uncommon and can be readily reversed by removing the plug. Dacryocystitis is a rare complication that can be avoided by making sure the lacrimal drainage system is open before inserting plugs. Plug loss and intracanalicular migration are reduced with proper size and insertion techniques and the adoption of newer plug designs. The most common consequence is plug loss, which affects up to 50% of patients within three months. Even when the plug is lost, the proximal canalicular stenosis associated with it may provide some relief. 1,4-6
Intracanalicular plugs, which can be difficult to remove, are connected with more frequent and severe issues. Dissolvable plugs are less likely to cause long-term problems, but it’s impossible to know if they’re in the right place or if they’re effectively blocking tear drainage.
Since the development of topical cyclosporine, the role of plugs has been questioned. Cyclosporine is effective, although it can take 3 months or longer to work, must be taken on a regular and long-term basis, is costly, only works in 60 percent to 75 percent of patients, and causes burning in approximately 15% of individuals. Punctal plugs, on the other hand, work right away and don’t cost or burden the patient in the long run.
I usually put plugs in individuals who want more rapid comfort and want to reduce their reliance on drugs. I don’t mind using both plugs and cyclosporine because they work well together. 4,7-10 Punctal plugs and cyclosporine will both remain significant treatments for aqueous deficient dry eye.
Back to the Shelf for Punctal Plugs
Punctal plugs have long been a mainstay of dry eye disease (DED) treatment, and were once regarded a first-line therapy. 1,3,11 However, our knowledge of dry eye has grown, and studies now show that inflammation plays a crucial part in the disease’s development. 12,13
Punctal plug efficacy is restricted, given our present understanding of DED, in that it exclusively addresses aqueous-deficient dry eye, has little effect on evaporative dry eye and concomitant blepharitis, and has little anti-inflammatory effect.
Punctal plugs, in fact, may aggravate dry eyes and blepharitis by trapping cytokines, chemokines, metalloproteinases, and T cells on the ocular surface, causing dry eye symptoms to worsen.
14 Because we know this is a progressive disorder that can eventually lead to considerable ocular surface damage if inflammation is not treated effectively, the inflammatory component of the disease has been a key target for successful therapy regimens. 13,14
The use of a topical cyclosporine solution instead of a punctal plug has various advantages. Cyclosporine boosts tear production, tear break-up time, and goblet cell density while lowering corneal staining with essential dyes, reducing the requirement for artificial tears. 7,8,13-15 Topical corticosteroids may be used in short courses prior to or concurrently with cyclosporine to alleviate dry eye symptoms until the cyclosporine reaches appropriate efficacy, allowing us to avoid putting artificial devices in the puncta and reducing the risk of epiphora, canaliculitis, canalicular obstruction, granuloma formation, extrusion, and corneal or conjunctival abrasions over time. 16,17
Punctal plugs are still used as an additional therapy to help individuals with aqueous tear insufficiency. Plugs, on the other hand, should no longer be used as a first-line treatment for dry eye since they have the potential to exacerbate the inflammatory component of the condition. Furthermore, plugs should only be utilized after inflammation has been controlled and the accompanying symptoms have been treated with anti-inflammatory medications.
References
- M. Balaram, D. A. Schaumberg, and M. R. Dana. Results of punctal occlusion with silicone plugs in dry eye syndrome: efficacy and acceptability. 131:30-36 in American Journal of Ophthalmology, 2001.
- Punctal occlusion for dry eye syndrome, Ervin AM, Wojciechowski R, Schein O. 2010;9(CD00679):1-31. Cochrane Database Syst Rev. 2010;9(CD00679):1-31.
- MC Tai, CB Cosar, EJ Cohen, CJ Rapuano, PR Laibson. Silicon punctual plug therapy’s clinical efficacy. Cornea, vol. 21, no. 1, pp. 135-139, 2002.
- M. Kaido, R. Ishida, M. Dogru, and K. Tsubota. To prevent intracanalicular plug movement, a new punctual plug insertion approach has been developed. 147:178-182 in American Journal of Ophthalmology, 2009.
- Long-term follow-up of punctual and proximal canalicular stenoses after silicone punctual plug treatment in dry eye patients. Bolden I, Klein A, Haller-Schober EM, Horwath-Winter J. 146:968-972 in American Journal of Ophthalmology, 2008.
- K. Sall, O. D. Stevenson, T. K. Mundorf, and B. L. Reis. Two multicenter, randomized investigations of cyclosporine ophthalmic emulsion effectiveness and safety in moderate to severe dry eye disease. Phase 3 Study Group for CsA. 107:631-639 in Ophthalmology, 2000.
- CW Roberts, PE Carniglia, and BG Brazzo. For the treatment of dry eye, a comparison of topical cyclosporine, punctal occlusion, and a combination. Cornea, vol. 26, no. 8, pp. 805-809, 2007.
- Self-reported compliance with topical cyclosporine emulsion 0.05 percent and beginning of the effects of increased tear production as determined through patient surveys, Trattler W, Katsev D, Kerney D. 1848-1856 in Clin Ther. 2006;28:1848-1856.
Can you rub your eyes with punctal plugs?
Punctal plugs rarely cause serious consequences. Some patients, however, may develop negative side effects.
A scratchy, slightly uncomfortable sensation in the corner of the eye is the most typical side effect. Most people get used to this sensation or discover that it goes away after a while.
- Inflammation. For longer lengths of time, the plugs might irritate or cause inflammation in the tear ducts. Anyone who notices these symptoms should see their doctor for an examination. The plugs should probably be removed since the inflammation could cause scarring or other harm to the tear duct.
- An allergic reaction has occurred. It is possible for someone to develop an allergic reaction to the plugs being inserted, albeit this is uncommon. The body may even reject the plugs totally, necessitating their removal.
- Eyes that are watering. Punctal plugs can sometimes function too well, causing a person to have wet eyes all of the time. Other therapeutic alternatives may be suggested by a doctor in this circumstance.
- Plugs that protrude. This is frequently caused by an incorrectly sized plug. Plugs can irritate the eye’s surface or the eyelid, and they can even slip out of the duct. One of the reasons doctors encourage regular examinations after the insertion is because of this.
Can you remove punctal plugs yourself?
You may rely on your eye doctor for hygienic care and storage if your eye doctor is the only one who removes punctal plugs. If you’re removing them yourself, however, you’ll have to keep them sterile. You can use a similar procedure to that of cleaning contact lenses. Make sure you wash your hands and the punctal plug container. Rinse them completely and store them in a sterile solution that has been approved or prescribed.
What are the side effects of punctal plugs?
Risks and Consequences of Using a Punctal Plug
- Plugs that don’t fit properly may protrude from the tear duct and brush on your eye’s or eyelid’s surface.