Treating Dry Eyes with Punctal Plugs: Silicone Plugs vs the SmartPLUG®

Are you sensitive to light? Do your eyes often feel gritty? Does your vision fluctuate? Does blinking improve your vision? Do you use artificial tear more than 3 times a day? Find your contact lenses uncomfortable?Graphic of Odyssey Silicone Punctal Plug for the treatment of dry eye syndrome These are just a few of the most common symptoms we hear when patients tell us their eyes feel dry and irritated. Dry eye syndrome is very common, especially in women. Treatment of dry eye syndrome is very beneficial with very little risk of complications. Punctal occlusion with silicone plugs is one of the most common modes of treatment.

We often use punctal plugs to increase the amount of tears present in a patient’s eyes. A recent study compared the two most common types of punctal plugs, silicone punctal plugs and the SmartPLUG®. Essentially the study found that they both were relatively equally effective in reducing a patient’s symptoms (over 55% of the patients reduced the use of artificial tears). The study evaluated only 36 eyes for less than 12 weeks which really was not enough patients over too little time. However, one would likely expect that as long as the punctal plugs remained in the eyes the patients would continue to do well. The study does show that treatment of dry eye syndrome with punctal plugs is an effective solution.

Interestingly, 33% of the eyes treated had a plug fall out during the 12 weeks, which is very high. In our practice we see approximately 5% of our patients per year lose a plug, a rate much more in line with other ophthalmic practices. A 33% loss makes me want to look for a problem with punctal plug sizes.

We use both types of punctal plugs used in the study, silicone plugs (made out of a rigid type of silicone) and the SmartPLUG® (made out of a thermodynamic gel). We find both to be very effective and helpful in different situations. I like the silicone plugs for most patients, it is easy to insert and verify that it is still in place doing its job. The SmartPLUG® is helpful in patients that find the silicone plugs irritating.

If you think you are experiencing the symptoms of dry eyes see your eye doctor and get some help. There are numerous treatments available, which we will cover in another article. At a minimum, patients typically note a significant decrease in symptoms with treatment.

If you would like to read a summary of the article it’s available here “SmartPlug versus silicone punctal plug therapy for dry eye: a prospective randomized trial”.

UPDATE: Check out this video on treating Dry Eye Syndrome with punctal plugs at Total Eye Care.

12 responses to “Treating Dry Eyes with Punctal Plugs: Silicone Plugs vs the SmartPLUG®

  1. Pingback: Q: Why are my eyes so dry lately? « The Eye Doc Blog

  2. Pingback: Dr. Driscoll and Dr. Green Speak on Dry Eye Syndrome « The Eye Doc Blog

  3. I have the SmartPLUG in my lower tear ducts, and I’ve devoloped what I thought to be a stie in one lower eyelid–in the corner away from the duct–that my eye Dr. believes also to be a stie.
    However, just a few minutes ago, I squeezed it, and out popped a cylindrical piece of what appeared to be plastic. I”m assuming this is the SmartPLUG, and I’m concered. The stie is still there and feels like there is more in it. My other eye has a similar problem right next to the duct, and I’m wondering if this is dangerous? I will be calling my eye Dr. on Monday, but is this dangerous to my eyes or my health, seeing it’s silicone?
    Thank you for you time and attention to this note. I appreciate any information you can give me.

    • Thanks for your comment. The SmartPLUG is safe and is not made of silicone as a matter of fact it will dissolve in warm water. The fact that the plug came out is not dangerous. Calling your doctor is a good idea, in the meantime warm compresses typically help resolve a stye. Antibiotics are sometimes necessary as determined by your doctor. One more thing, don’t squeeze the stye any more it can cause the stye to spread to more lid tissue.

  4. Thank you so much for your response. My eye Dr. did prescribe warm compresses and massage for this when I last saw her, and I’ll continue to do so. If no improvement, I will call her and let her know what’s happening.
    Thanks again for your timely advice. I appreciate it and you very much!

  5. Thank you,
    very interesting article

  6. i have tried every kind of eye drops i recently had the plugs and still didnt resolve my dryness i still have the burning and stinging sensation what would u recommend at this point is there any way to find out what going on why my eyes are not producing tears thank u plz reply

  7. hello,
    myself stany from india,
    i am suffering from severe dry eyes syndrome, even restasis couldnt help me, i have tried silicon plugs in both eyes but i lost them thrice.
    Now i want to have smart plugs, but they are not available in india. Can you tell me from where i can buy them? Or which company is making them?

    • That is a good question. The SmartPLUG is produced by Medennium. It is not really something you can insert yourself. I don’t know if they export to India. I would recommend you or your eye doctor contacting them and see if they well send their punctal plugs to India

  8. i have sent a mail to the company regarding this, now waiting for their reply.
    its my last hope, so kept my fingers crossed.

    thanks for replying.