Keeping natural tears in the eyes longer can reduce the symptoms of aqueous deficiency dry eye. This can be done by blocking the tear ducts (punctal plug) through which the tears normally drain or wearing moisture chamber spectacles/goggles.
Punctal Plug Occlusion
Punctal plugs block the puncta and prevent tears from draining, which may increase the total volume of tears in your eyes, prolongs the effect of lubricants and improve your tear film.
- Temporary plugs
- Are made from absorbable collagen, and typically last 1-2 weeks before dissolving
- These short-term collagen plugs are best used before or after eye surgery (LASIK and cataract surgery) to prevent the onset of dry eyes, or to determine if a dry eye patient gets relief from temporary punctal occlusion before trying more long-term options
- Semi-permanent and permanent plugs
- Are made from non-dissolvable silicone, and can last six months to several years
- Other materials include acrylic, hydrogel and polydioxanone
Indications:
- They are considered when lubrication eye drops, prescription eye drops and secretagogues are ineffective or impractical.
- It is indicated also indicated in patients having a Schirmer's test result of <5 mm at 5 min
Complications
- Extrusion or migration - which is why finding the best fitting plug is key
- Epiphora (excessive tearing)
- Foreign body sensation near the plug placement
- Typically avoided in patients who have concurrent blepharitis or other forms of eye and eyelid inflammation - The plugs could serve as a source for ongoing inflammation, and prevent the drainage of inflammatory markers in the tear film, which may actually worsen dry eye symptoms.
Recent meta-analyses have shown inconclusive results for the use of punctal plugs on the treatment of dry eye symptoms and signs.
Moisture Chamber Spectacles/Goggles
Moisture chamber spectacles/goggles are eyeglasses specially designed to slow evaporation of the tears, by providing a humid environment and minimizing airflow over the ocular surface. These are particularly useful in treating evaporative and aqueous deficiency dry eye.
Thy can be worn alone, or under other glasses. Moisture chamber goggles allows some air to teach the eye, an important factor because oxygen is important to eye health.