a. Inspect the patient’s punctum to determine which size plug to use.

b. Remove a sterile packet from the box, peel back the lid and remove the foam holder.

c. While using magnifying loupes or a slit-lamp, have the patient look away from the point of insertion.

d. Use a jeweler’s forceps to remove one of the plugs from between the grooves in the foam holder. (See video instructions)

e. Apply traction with a cotton tip applicator to evert the eyelid and clearly view the punctum.

f. Guide the plug partially into the punctum and release the forceps (fig. 1).

g. Apply lateral traction with the cotton tip applicator to straighten the angle between the vertical and horizontal canaliculus (fig. 2).

h. Use the tips of the forceps to push the plug out of sight into the horizontal canaliculus (fig. 3).

i. Blinking and normal tear flow cause the plug to migrate down into the horizontal canaliculus (adjacent to the common canaliculus).

j. Repeat the same procedure for each remaining punctum. After insertion, inspect each punctum to ensure the plugs are not sticking out (fig.4).Unused plugs should be discarded.

Plug insertion (fig. 1-4) is the same for inferior and superior puncta. To optimize results place two plugs in each punctum.

Following Placement

Collagen Plugs absorb the tear fluid and expand to nearly 150% of their original diameter. They become very soft and patients should feel little or no discomfort.

For patients experiencing irritation or tearing after plug insertion, use a sterile probing device such as the Williams Intracanalicular Plug Positioning Tool (WIPPT) to confirm proper placement within the horizontal canaliculus (4-6 mm beneath the punctum).

Use a single drop of topical antibiotic to prevent complications related to plug insertion.

Considerations

During insertion be careful not to perforate the canaliculus with the jeweler's forceps. Perforation can increase the risk of infection. If perforation occurs, delay insertion until the wound heals.

This product enhances the efficacy of ocular medications. Depending on the type of medications being used, dosage may need to be reduced accordingly. Use of a topical antibiotic prior to insertion is recommended. Practitioners should use discretion if infection is present.

Disclosure

Before using Collagen Plugs patients should be informed about benefits, risks and alternatives. Have patients sign an Informed Consent Form (Request for Testing) to document receipt of this information.

Page 1 - Introduction to Dissolvable Collagen Plugs (Short-Term)