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Indications for punctal plugs

Indications for punctal plugs. dry eye after trying artificial tears collagen trial (first 10 days) improve for 4-5 days epiphora is contraindication s/p lasik. Equipment for punctal plugs. forceps dilator (?) anesthetic (?) plugs: collagen--“trial”

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Indications for punctal plugs

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  1. Indications for punctal plugs • dry eye • after trying artificial tears • collagen trial (first 10 days) • improve for 4-5 days • epiphora is contraindication • s/plasik

  2. Equipment for punctal plugs • forceps • dilator (?) • anesthetic (?) • plugs: • collagen--“trial” • silicone—permanent “Herrick” plugs

  3. dilation & irigation • D&I • Jones 2 test • Indications: • negative Jones I test • epiphora • Rule-out: • dry eye • ectropian • congenital nasolacrimal obstruction (6% of children; majority resolve on their own) • Contraindications • active infection (dacryocystitis)

  4. interpretation of dilation & irrigation • salty taste in throat • positive “Jones 2” test  obstruction flushed out • fluid out superior puncta • blockage in common lacrimal duct • no fluid • blockage in distal part of system (valve of Hasner, e.g.)  refer for surgery

  5. Indications for scleral indentation technique • flashes • floaters • spots • hazy or decreased vision • history of blunt trauma • high axial myopia • aphakia • any previously diagnosed peripheral retinal anomaly

  6. contraindications for scleral indentation • recent intraocular surgery • hyphema • trauma to globe

  7. FB removal considerations • evaluate depth of FB with optic section through SL • stain cornea & check for Seidel’s sign • remember the cornea is tough, pliable & heals quickly • Options: • surface  rinse with sterile saline • moistened Q-tip  from side! don’t make FB deeper • 25 gauge or smaller (higher #) needle • spud club  from side tangentially • alger brush  metal / rust ring

  8. FB removal post procedure? • NaFl abrasion assessment • abrasion present? Consider: • bandage CL • topical antibiotic • homatropine / NSAIDs / pain mgmt (opioid analgesics) • RTC 1-2 days.

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