PUNCTAL PLUGS....

Edinburgh optometrist David Crystal MCOptom DipTp specialises in diagnosing and treating the root cause of dry, watery or uncomfortable eyes using advanced techniques at the forefront of the optometry profession.

For dry eyes caused by simply not having enough tears, relief is provided by either conserving tears with plugs or by supplementing tears with eyedrops.

SHORT TERM RELIEF USING TEAR SUPPLEMENTS

For temporary dry eye problems, artificial tears offer immediate relief. With over 65 products to choose from the scientific goal is to formulate lubricants which act just like human rears, which are surprisingly complex. Despite advances, none yet contain the natural antibiotics Lactoferrin, Lysosyme or any of the immunogobulins that protect and hydrate the eye's surface. Our experience is that of the best products containing sodium hyaluronate, only those of low osmolarity and high viscosity, such as Vismed or the unpreserved eye-drops Ocudry 0.3%, provide a reasonably long lasting relief for dry eyes. There is no substitute for your own tears.

LONG TERM RELIEF BY PUNCTAL OCCLUSSION

In cases of more persistent dry eye symptoms, closure of the tear ducts with punctal plugs, may be the best option. This conserves precious tears by restricting drainage. Your eyes are bathed with your own natural tears without the bother of constantly supplementing the tear film with artificial drops. Punctal plugs act very much like a stopper in the sink preventing precious tears being lost. As the tear reservoir builds. the self lubricating process begins

Unless you have a purely evaporative dry eye, plugs will help - its just a question of by how much. Some patients find they can stop using drops altogether.

David Crystal has extensive experience in this field and has fitted hundreds of punctal plugs of all designs and types to both upper and lower tears ducts. The insertion procedure is easy and comfortable and is performed in the practice. Once the plugs are fitted you are unable to feel them in your eye. The plugs are permanent, with no ongoing replacement costs, yet can easily be removed at a later should your dry eye condition improve.

Different plug designs are available in a range of sizes so each patient requires individual assessment.

If you already know a little about plugs, then please be advised we no longer fit extended duration dissolvable plugs into the lower tear ducts. With experience we found this type of plug, called an intra-canicular plug which is fitted deeper into the duct opening, often failed to expand fully to restrict drainage. Our patients only experienced partial relief. Worse still, as these plugs dissolve over three months they become even less effective and so a never ending cycle of costly plug replacement is needed.

Crystal Optometry has over 12 years experience with the longterm effects of punctal occlusion. The permanent intracanicular plugs had a 12% infection rate.

We have never seen infection from non-dissolvable silicone punctal plugs - which are surface mounted - and we have found these give maximum relief from the symtoms of dry eye. There are no medical risks with this type of plug and there are no ongoing costs unless a plug is accidently lost.