Bandage Contact Lenses and Punctal Plugs: Indications, Choosing the Size and Type, Fitting and Follow-Up
Last updated: November 2026
Two small devices solve many ocular surface problems in the clinic. A bandage contact lens protects and comforts the cornea while it heals. A punctal plug keeps natural tears and drops on the eye for longer. Both are simple, but choosing the right type and size and following the patient up properly prevents complications.
Bandage contact lenses: when
- Corneal abrasion and recurrent erosion, after removal of loose epithelium.
- After PRK, epithelial debridement, pterygium surgery and corneal cross-linking.
- Persistent epithelial defect (with lubricants), filamentary keratitis, bullous keratopathy pain.
- Small wound leaks or perforations (with or without glue).
- Protecting the cornea from trichiasis or sutures until definitive treatment.
Choosing and fitting
| Point | Recommendation |
|---|---|
| Material | Silicone hydrogel with high oxygen transmissibility, approved for extended or therapeutic wear |
| Diameter | Usually 14–14.5 mm; larger (15–16 mm) lenses for big defects or limbal coverage |
| Base curve | Commonly 8.4–8.8 mm; choose by fit, not keratometry alone |
| Fit | Centred, full corneal cover, slight movement (about 0.5 mm) on blinking; avoid a tight lens |
| Power | Plano usually; a powered lens can be used for vision |
Bandage lens rules
- Give a broad-spectrum antibiotic drop (preservative-free if possible) while the lens is in and the epithelium is open.
- Avoid steroid-only cover with an open epithelial defect unless closely monitored.
- Review in 1–3 days for infection and lens position, then regularly.
- Replace the lens at least monthly (or as the product allows); remove when healed.
- Teach warning signs: increasing pain, redness, discharge, reduced vision.
Punctal plugs: when
- Aqueous-deficient dry eye not controlled with preservative-free lubricants.
- To improve the effect of drops (e.g. after refractive surgery, contact lens dryness).
- Avoid in active lid margin disease, blepharitis or meibomian gland dysfunction with inflammation (plugs keep inflammatory tears on the eye), dacryocystitis, and allergy to the material.
Plug types
| Type | Duration | Notes |
|---|---|---|
| Collagen (intracanalicular) | Dissolves in days to weeks (some up to months) | Trial to see if occlusion helps before permanent plugs |
| Synthetic absorbable (e.g. polydioxanone) | Up to about 3–6 months | Longer trial |
| Silicone punctal plug (with a cap at the punctum) | Long term, removable | Visible cap; size it to the punctum |
| Intracanalicular non-absorbable (e.g. thermosensitive acrylic) | Long term | Cannot be seen; removal may need irrigation or surgery |
Sizing and insertion
- Measure the punctum with a gauge or sizer (common sizes about 0.4–1.0 mm). Choose the largest plug that fits snugly without forcing; too small falls out, too large causes discomfort or damage.
- Usually start with the lower punctum, which drains most of the tears; add the upper if needed.
- Dilate the punctum gently if necessary; insert with the loader aligned with the canaliculus (vertical, then horizontal), and check the cap sits flat.
Complications
| Device | Complications |
|---|---|
| Bandage lens | Microbial keratitis (most serious), lens loss, tight-lens syndrome, deposits, neovascularisation |
| Punctal plug | Extrusion, epiphora, irritation or granuloma, migration into the canaliculus, canaliculitis or dacryocystitis |
Pearls
- Silicone hydrogel, 14–14.5 mm, with antibiotic cover and early review is the safe default bandage lens.
- Start with a collagen plug as a trial if unsure whether occlusion will help.
- Treat lid disease before plugging the puncta.
Common mistakes
- Leaving a bandage lens in for weeks without review.
- Plugging an eye with active blepharitis.
- Using a plug that is too small and keeps falling out.
Test yourself: flip cards
Quick quiz
Related: TFOS DEWS III: What Changed in Dry Eye Diagnosis and Treatment, Autologous Serum Eye Drops: Indications, Step-by-Step Preparation, 20% vs 50%, Storage and Safety, Contact Lens Quick Reference and Fitting Guide: Vertex, LARS, RGP Patterns, Irregular Cornea and Scleral Lenses, Amniotic Membrane in Eye Surgery: Which Side Is Up, Dry vs Wet Membrane, Inlay, Onlay and Fixation, Cornea.
Key sources
- TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15:575-628
- Ervin AM, Law A, Pucker AD. Punctal occlusion for dry eye syndrome. Cochrane Database Syst Rev. 2017;6:CD006775
- Lim L, Lim EWL. Therapeutic contact lenses in the treatment of corneal and ocular surface diseases: a review. Asia Pac J Ophthalmol. 2020
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