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.

Following Placement

Patients should feel little or no discomfort following plug placement.

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 plug insertion until the wound heals.

Disclosure

Before using Dissolvable OPAQUE Herrick Lacrimal Plugs, patients should be informed about benefits, risks, and alternatives. Have patients sign an Informed Consent Form (Request for Treatment) to document receipt of information.

Seeing Dissolvable OPAQUE Herrick Lacrimal Plugs

Anytime after insertion (see video instructions), or during removal (see video instructions) procedures, use a simple light source to transilluminate the eyelid and visualize the location and movement of Dissolvable OPAQUE Herrick Lacrimal Plugs.

Removal

Pressure irrigation with the TruPro™ Lacrimal Cannula (fig. 5) (see video instructions) or with the West Lacrimal Cannula (combines irrigation and probing), is the preferred method for plug removal. In rare cases, when this method proves unsuccessful, surgical removal may be required.

Page 1 - Introduction to Dissolvable OPAQUE Herrick Lacrimal Plugs® (Medium-Term)