Plain and Simple Ocular Punctal Plug Removal: Part II

​Ocular punctal plug removal is a straightforward procedure easily completed in the emergency department. Serious complications from punctal plug insertions are rare but sometimes seen.Left: A punctal plug in the upper lacrimal duct of the right eye, allowing for moisture balance from tear production. Right: The tiny punctal plug after it was removed. Photos by M. Roberts.Punctal plugs are placed in some or all of the lacrimal ducts by an ophthalmologist to treat chronic dry eye, and can be permanent or dissolvable. Plugs typically stay in place for three months or longer. (Am J Ophthalmol. 2007;144[3]:441.) The most common complications are localized irritation and dislodgement with foreign body sensation and epiphora within the first 48 hours. Other complications include corneal abrasions, conjunctivitis, dacryocystitis, and canaliculitis.Call the ophthalmologist who placed the punctal plugs or the on-call ophthalmologist if a patient presents with related complaints. The ophthalmologist may have needed to dilate the lacrimal ducts, which can cause irritation in the first 24-48 hours. Typically, proparacaine or tetracaine can soothe the eyes during the initial transition. It is important to know the day and time of the original procedure to determine if the irritation is from insertion or long-term use.The plugs can cause deleterious effects such as blurry vision if epiphora occurs. Patients may also have continued irritation or dislodgement of the plug. If th...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs