instrumental strategies
An Easy Fit for Dry Eyes
The Medennium SmartPLUG reshapes itself to provide an exact fit.

STUART GINDOFF, O.D., M.B.A., F.A.A.O.

In my practice, I've found that the Medennium SmartPLUG represents a significant advancement in the treatment of dry eye. The plug inserts easily, offers economic benefits for my practice and leaves patients ecstatic. Here I'll describe the SmartPLUG and its advantages.

A break from tradition

The traditional punctal plug is made of silicone. The lower portion is pointy and guides the plug into the hole of the punctum. The top of the plug is flat and works as an anchor so it won't fall totally beneath the surface of the punctum.

The plugs come in different sizes and you must measure the puncta to determine the proper size. If a plug doesn't stay in the punctum, you may then try a larger plug, which would fit more snugly.

	The SmartPLUG measures 9 mm by 0.4 mm.

Warming to the challenge

The SmartPLUG, on the other hand, is a rigid acrylic rod that measures 9 mm by 0.4 mm at room temperature, so it fits easily into the punctum. Only a topical anesthesia is required during insertion.

The plugs are tiny so you should take special care in opening the SmartPLUG packaging. Using centrally grooved forceps, which are available from Medennium, you place one-third of the plug into the punctum. Warming to body temperature, the SmartPLUG shrinks in length and expands in width. In about 30 seconds, the device reshapes itself into a softer, gel-like plug that is the exact shape of the punctal canal.

This exact shape provides a total occlusion that is so effective that I don't have to insert the plugs into all four punctal canals -- I typically insert them into the lower two. The entire procedure takes no more than one minute for each plug.

When I first started inserting the SmartPLUG I used a slit lamp, although I now prefer a head-mounted magnifying loupe with halogen illumination.

One size fits all

Because the SmartPLUG reshapes itself, one size fits all. You don't have to dilate or measure the punctum. In addition, the SmartPLUG has eliminated the need for my practice to carry an inventory of five different size plugs.

Once the SmartPLUG is in place, nothing protrudes from the punctum -- unlike rigid silicone plugs. Exposed heads may irritate or cause discomfort and patients may find the designs of silicone plugs cosmetically unappealing. Also, because the SmartPLUG is made of an acrylic polymer, there's no need to worry about allergy or the patient's sensitivity to silicone.

The SmartPLUG will not rub out or fall out; removal, however, is not difficult. You introduce a cannula into the lower punctum and irrigate using a syringe of saline solution. The downward pressure of the saline on the device makes the hydrophobic material slippery, which eliminates any adhesion and allows it to flush out easily.

No complications

I'm happy to report that after using the SmartPLUG for four months with 25 patients, I've observed no complications.

If the SmartPLUG interests you, you can contact the manufacturer at (888) 727-6100 or e-mail at info@medennium.com.

DR. GINDOFF IS AN ASSOCIATE CLINICAL PROFESSOR AT NOVA SOUTHEASTERN UNIVERSITY COLLEGE OF OPTOMETRY AND AN ASSISTANT CLINICAL PROFESSOR OF OPHTHALMOLOGY AT THE UNIVERSITY OF SOUTH FLORIDA COLLEGE OF MEDICINE. HE IS THE CEO OF MOBILE GLAUCOMA SERVICE, INC., AND HE IS ALSO IN PRIVATE PRACTICE AT EYE CENTER SOUTH IN SARASOTA, FLA.