Comprehensive Review of the Literature on Existing Punctal Plugs for the Management of Dry Eye Disease

Table 2

Punctal plugs [18–25] (types of punctal plugs, manufacturers, and characteristics discussed in detail).

Name	Size	Material	Characteristics	Manufacturer
Soft Plug	5 sizes (0.4–0.8 mm); (micro, mini, petite, small, and medium)	Medical grade silicone	Pointed nose simplifies insertion; large anchor secures plug.	Oasis
Plug 1	1 size; (fits 0.5–0.8 mm puncta)	Silicone	Dual lobed design to fit a range of punctal sizes.	EagleVision
SuperEagle; Plug	Small (0.4–0.6 mm); Medium (0.6–0.8 mm); Large (>0.8 mm); Values = puncta size	Low durometer silicone	Low durometer silicone with low profile rim for more comfort. Tapered shape and wide flexed nose design with a goal of good retention.	EagleVision
SuperFlex; Plug	11 sizes (combinations with 0.3–1.3 mm diameter, 1.1–2.0 mm length)	Silicone	Better fit with good retention. Easy insertion.	EagleVision
EaglePlug	5 sizes (0.4–0.8 mm)	Silicone	Tapered shaft exerts horizontal force to keep plug in place. Easy insertion and removal.	EagleVision
EagleFlex Plug	6 sizes (0.4–0.9 mm)	Silicone	Tapered shaft with traction ribs for better retention and flexibility. External ribs give 30% more surface area. Thin rim decreases corneal contact.	EagleVision
LacriPro Punctum	4 sizes (0.3, 0.5, 0.7, and 0.9 mm); (X-small, small, medium, and large)	Medical grade silicone	Reservoir indentations trap tears and decrease foreign body sensation. The number of indentations corresponds to the size of the plug.	Lacrimedics
Parasol; Punctal Occluder	X-small (0.25–0.35 mm); Small (0.35–0.65 mm); Medium (0.6–0.85 mm); Large (>0.9 mm); Values = puncta size	Silicone	Hollow nose. Umbrella-like head which squeezes as it is inserted and springs open once in place. No need for punctal dilation.	Beaver-Visitec
Snug Plug	1 size fits all	Silicone	Preloaded in a stretched position and returns to natural shape after insertion (Figure 4).	FCI
Ready-Set	7 sizes (0.4–1.0 mm); (slim mini, slim petite, micro, mini, small, medium, and large)	Silicone	Slanted lip in sizes 0.6 mm and larger makes it a better fit. Conforms to natural anatomy of the eyelid. Sizes 0.6 mm and larger also have slightly larger bulbs to resist migration and prevent rubout.	FCI
TearSaver	5 sizes (0.4–0.8 mm)	Silicone	Tapered shaft exerts extra horizontal force to keep plug in place.	FCI
UltraPlug	5 sizes (0.4–0.8 mm)	Silicone	Straight shaft. Low profile cap design minimizes foreign body sensation.	Surgical Specialties Corporation
VeraPlug	Small (0.4–0.6 mm); Medium (0.6–0.7 mm); Large (0.7–0.8 mm); X-Large (0.8–1.0 mm); Values = puncta size	Silicone	Low profile dome for more comfort. Proprietary shaft design for easy insertion and good fit (Figure 5).	Lacrivera
Quintess Punctal Occluder; (AquaFlo)	4 sizes (0.3, 0.5, 0.7, 0.9 mm); (X-small, small, medium, and large)	Silicone	Reservoir indentations are designed to decrease foreign body sensation. Indentations correspond to plug size (Figure 5).	AlphaMed
Soft Plug Flow; Control	3 sizes (0.6–0.8 mm)	Soft silicone	Partial occluder. Opening through nose portion for partial occlusion. Low profile dome head. Softer, flexible silicone makes it more comfortable. Pointed nose secures it firmly. Patent lumen allows for use in punctal stenosis.	Oasis
Eagle Flow; Controller	4 sizes (0.5–0.8 mm)	Silicone	Tapered shaft. Partial occluder. Patent lumen allows for use in punctal stenosis. Tapered shaft increases vector force to keep the plug in position.	EagleVision
EaglePlug; TearFlow	6 sizes: 0.5 mm plug, 0.2 mm lumen; 0.6 mm plug, 0.3 mm lumen; 0.7 mm plug, 0.3 mm lumen; 0.8 mm plug, 0.3 mm lumen; 0.9 mm plug, 0.4 mm lumen; 1.0 mm plug, 0.5 mm lumen	Silicone	Partial occluder. Lumen size is 150% larger than Eagle Flow Control plug allowing for increased tear flow. Tapered shaft gives more controlled retention. Patent lumen allows for use in punctal stenosis.	EagleVision
Microflow	Small (0.4–0.55 mm); Medium (0.55–0.7 mm); Large (0.7–0.85 mm); Values = punctal size	Silicone	Partial occluder. Patent lumen allows for use in punctal stenosis.	Beaver-Visitec
Perforated; punctal plug	2 sizes (0.7, 0.9 mm); (mini, medium)	Silicone coated with PVP (polyvinylpyrrolidone)	Partial occluder. Slanted collarette. PVP (polyvinylpyrrolidone) is hydrophobic and allows tear to flow smoothly through the perforation. Used in treating punctal stenosis.	FCI