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Pull the plug on Dry Eye

(I-MED Pharma)

Dry eye disease (DED) is a condition that affects over 340 million people worldwide. There are two forms of DED: evaporative dry eye (EDE) and aqueous deficient dry eye (ADDE). EDE occurs when the eyes do not produce the right quality of tears, resulting in the tears not being able to properly lubricate the eye. ADDE occurs when the eyes do not produce a sufficient amount of tears to keep the eyes moisturized. Both forms of dry eye can result in eye irritation, pain, and damage to the eye. [1] However, in cases of ADDE, punctal plugs, inserted during a punctal occlusion procedure, can serve as an effective way to help relieve symptoms related to dry eye.

What are punctal plugs and how do they work?

Punctal plugs, also known as punctal occluders or lacrimal plugs, are extremely small biocompatible devices that are inserted into the tear ducts, called the puncta, to help conserve tears. Puncta are tiny openings that drain tears from the eyes. Punctal plugs work by preventing the drainage of tears through the puncta, which then allows the eyes to remain lubricated and moisturized. [2] It’s the equivalent of putting a plug in a bathtub to make sure that the water stays in the tub. The plug in the puncta prevents the tears from draining out, which keeps the eye lubricated.

Punctal plugs from I-MED Pharma – also known as punctal occluders or lacrimal plugs

Types of punctal plugs

There are different forms of punctal plugs, depending on the needs of the patient and the cause of their dry eye disease. Some of the most used types of punctal plugs include:

  1. Temporary punctal plugs: Temporary punctal plugs are usually made from collagen, a material that’s found in bone and skin.[3] They typically dissolve on their own after a few weeks or months. [4]
  2. Permanent punctal plugs: Permanent punctal plugs are usually made from materials that are more durable, such as silicone. [5] They can be removed if needed, but they are not designed to dissolve on their own. [6]

Punctal plug sizes

Punctal plugs come in different sizes, which can be selected to fit the size of each patient’s tear duct. A doctor will often use a size gauge to determine the correct size of punctal plug based on the specific needs of the patient.

Punctal plug insertion and removal procedure

Schema diagram of a punctal plug procedure

Punctal plugs can be inserted by either an ophthalmologist or an optometrist, depending on which province you live in. The process is as follows:

  1. Anesthetize the area of the punctum with a topical anesthetic placed in the conjunctival sac.
  2. Apply a drop of saline solution or artificial tears onto the punctal plug to help ease insertion.
  3. Position the insertion instrument by placing the forefinger on the release button of the inserter and placing the occluder end of the insertion instrument over the patient’s (superior or inferior) punctum.
  4. Vertically insert the punctal plug by positioning the occluder into the punctum until the cap is flush with the punctal opening. [A]
  5. When the occluder is properly seated, depress the release button and withdraw the insertion instrument. [B]
  6. Verify that the occluder is properly placed by confirming that the cap is flush with the punctal opening. [C] After insertion, monitor the placement and integrity of the occluder to determine if/when the occluder may need to be replaced.


Should removal be indicated, grasp the vertical shaft of the occluder underneath the exposed cap with sterile forceps. Gently pull upward until the plug is removed. [D]

Effectiveness & benefits of punctal plugs

Studies have shown that punctal plug insertion is a simple, effective, safe, and reversible method to treat aqueous tear deficiency. [7] In fact, most people notice an improvement in dry symptoms within the first few days. [8] Furthermore, studies have shown that there is both a reduced dependency on artificial lubricants, as well as a demonstrated relief of dry eye symptoms after the usage of punctal plugs. [9] Research published in Cornea, a journal specializing in the latest research on the cornea and the anterior segment of the eye, demonstrates the effectiveness of punctal plugs, where researchers saw a 94.2% reduction in dry eye symptoms. These symptoms included dryness, watery eyes, itching, burning, sandy/foreign body sensation, fluctuating vision, and light sensitivity. There was also a 93.0% reduction in conjunctival sign and symptoms, such as redness and discharge, at the eight-week follow-up after progressive occlusion with collagen and silicone plugs. [10]

Punctal plugs are a minimally invasive option that can help treat dry eye quickly and easily. The results can be very noticeable early on after the procedure, plus, no medication or surgery is required. [11]

Punctal plug options available from I-MED Pharma:

I-PLUG® FIT – Improved Flexible Fit for Chronic Dry Eye – Punctal Occluder – Available in multiple sizesI-PLUG® FIT – Improved Flexible Fit for Chronic Dry Eye

I-PLUG® FIT punctal plugs are designed for simple sizing, easy insertion, patient comfort and retention – providing a proven treatment for chronic dry eye.  These punctal plugs are meant to be permanent, however, they are reversible and can be removed if needed. Two sizes fit most patients for simple sizing.

Features include:

  • Molded from medical grade silicone.
  • Flexible fit nose design provides easy insertion and superior retention
  • Punctal Plug 30-Day Retention Pledge - I-PLUG® FIT Free Replacement from I-MED PharmaLow-profile dome for increased patient comfort
  • Choose from sterile preloaded or non-sterile bulk
  • Available in x-small, small, medium, and large

If an I-PLUG® FIT is lost within 30 days of insertion, I-MED Pharma
will replace it free of charge.

I-PLUG® – Punctal Plug or Lacrimal Plug for Chronic Dry Eye – Available in multiple sizes


I-PLUG® punctal plugs are designed to provide a simple and effective treatment for chronic dry eye and help reduce or eliminate tear drainage through the inferior or superior puncta, thus maintaining lubrication on the surface of the eye.

Features include:

  • Molded from medical grade silicone
  • Conforms perfectly to the puncta for unparalleled retention
  • Low-profile dome for enhanced patient comfort
  • Proprietary shaft design for easy insertion and proper anatomic fit
  • Choose from sterile-preloaded (small, medium, large, or x-large) or non-sterile bulk (small, medium, large)

Consult with your Eye Care Professional about a Punctal Plug Procedure for Chronic Dry EyeIn conclusion, punctal plugs are a simple, effective, and reliable way to relieve dry eye symptoms. The method of insertion is non-invasive, and the procedure can be done quickly in an eye care professional’s office. There is no recovery time, and activities can be resumed the same day. If you’re suffering from dry eye and wish to learn more about punctal plugs, find an eye care professional near you and see the difference that punctal plugs can make.

[1] Jewell, T. (2022, October 18). Aqueous-deficient dry eye symptoms, causes, and treatment. Healthline.

[2] Boyd, K. (2022, March 8). Punctal plugs. American Academy of Ophthalmology. Retrieved February 22, 2023, from

[3] Maurer, K. (n.d.). Punctal Plugs. University of Michigan Health System. Retrieved February 22, 2023, from

[4] Eye Physicians of Long Beach. (2021, August 30). Punctal plugs.

[5] Maurer, K. (n.d.). Punctal Plugs. University of Michigan Health System. Retrieved February 22, 2023, from

[6] Maurer, K. (n.d.). Punctal Plugs. University of Michigan Health System. Retrieved February 22, 2023, from

[7] Tai MC;Cosar CB;Cohen EJ;Rapuano CJ;Laibson PR; (2002, March). The clinical efficacy of silicone punctal plug therapy. Cornea. Retrieved February 23, 2023, from

[8] Neal, B. (2019, October 16). Punctal plugs for dry eye disease. Neal Eye Group. Retrieved February 23, 2023, from

[9] Balaram M;Schaumberg DA;Dana. (2001, January). Efficacy and tolerability outcomes after punctal occlusion with silicone plugs in dry eye syndrome. American journal of ophthalmology. Retrieved February 23, 2023, from

[10] Abby Gillogly, O. D. (2016, June 15). Plug the drain with lacrimal occlusion. Review of Optometry. Retrieved February 23, 2023, from

[11] Neal, B. (2019, October 16). Punctal plugs for dry eye disease. Neal Eye Group. Retrieved February 23, 2023, from