A punctal plug is a small, biocompatible device inserted into the tear duct to manage chronic dry eye disease. These devices function by blocking the lacrimal punctum, the small drainage hole located in the corner of the eyelids near the nose. By preventing natural tears from draining away too quickly, the plug helps keep the eye’s surface moist and comfortable. While they are designed to remain in place, plugs can occasionally become dislodged.
Immediate Physical Indicators of Plug Loss
The loss of a punctal plug may sometimes be accompanied by a physical sensation. Patients might feel a sudden, brief foreign body sensation in the inner corner of the eye, particularly when rubbing the eye or washing the face. This fleeting feeling occurs as the tiny device exits the tear duct opening.
In some cases, the patient may actually see the plug after it has been expelled from the punctum. Punctal plugs are very small, often no larger than a grain of rice, but they can sometimes be noticed on a tissue or in the sink basin. If a semi-permanent silicone plug is only partially displaced, it may protrude slightly from the tear duct opening, causing momentary irritation against the eye or eyelid. Dissolvable plugs are less likely to be seen as they are designed to absorb into the body or wash away quickly with tears.
Recognizing the Return of Dry Eye Symptoms
The most telling evidence that a punctal plug has been lost is the recurrence of the original dry eye symptoms. Its absence means tears begin to drain at the previous, faster rate. This functional loss often leads to a gradual return of discomfort hours or days after the plug has dislodged.
Patients frequently notice a return of the gritty or scratchy sensation, similar to having sand in the eye. The eyes may also exhibit increased redness, burning, or stinging sensations as the tear film destabilizes. Increased tearing or watery eyes can also signal the plug’s loss, as the eye attempts to compensate for the dryness with reflex tears. Another common sign is an increased dependence on artificial tear drops, since the relief provided by conserved natural tears disappears.
What to Do If You Suspect the Plug is Missing
If you suspect a punctal plug has fallen out, contact your eye care specialist for guidance. While the loss of a plug is common and not considered an emergency, timely replacement is necessary to maintain the benefits of the treatment. You should avoid attempting to reinsert the plug yourself, as this can cause irritation or damage to the tear duct opening.
The eye doctor will confirm the plug’s status with a quick, non-invasive examination using a slit lamp microscope. This magnification allows the doctor to visualize the punctum and determine if the device is present, partially displaced, or completely gone. If the plug is confirmed missing, the replacement process can often be performed immediately during the same office visit.