Abstract: SmartPlugs

[Rebecca Petris]

I don't care what this study says, I still say DON'T DO IT. I hate SmartPlugs as you all know. The complications may not be widespread but when they happen they are bad, and since good alternatives to this kind of plug exist, there's just no point exposing yourself. Tempting because they're comfy, but... I hate 'em. Too many people have had to have unnecessary surgery on their eyelids dealing with these stupid plugs going places they were never meant to travel.

Clinical efficacy of the SmartPlug™ in the treatment of primary Sjogren's syndrome with keratoconjunctivitis sicca: one-year follow-up study.

To evaluate the efficacy of a thermo-sensitive punctum plug, (SmartPlug™) in Primary Sjogren's Syndrome (pSS) patients with dry eyes, whose symptoms persist despite preservative-free artificial tear treatment. In this study, 22 Primary Sjögren's Syndrome (pSS), as defined by American-European Consensus Group Classification Criteria. All patients being followed up by Ege University Departments of Rheumatology and Ophthalmology. The patients had positive Schirmer test results (<5 mm without anesthesia). SmartPlug™ (Medennium, Irvine, California, USA) was inserted into the inferior lacrimal canaliculi of both eyes. Visual acuity measurements, Schirmer I test measurements, lissamine green staining scores, and tear-film breakup times (BUT) were noted before plug insertion and at the 1st, 6th, and 12th months following the procedure. Minimum follow-up period was 6 months for 19 patients and 12 months for 16 patients. Significant improvements were seen in the Schirmer I test scores (before insertion: 1.98 ± 2.67; 1st month: 5.68 ± 6.69; 6th month: 5.35 ± 5.38; 12th month 6.43 ± 5.14 P = 0.006), tear-film BUT in seconds (before insertion: 4.64 ± 3.7; 1st month: 5.80 ± 2.36; 6th month: 7.53 ± 2.92; 12th month 7.50 ± 2.52, P < 0.0001), respectively. Thermodynamic punctum plug insertion only in inferior canaliculus is a simple, effective, and comfortable option for treatment of severe aqueous tear deficiency that cannot be controlled using preservative-free tears.

Rheumatol Int. 2011 Dec;31(12):1567-70. Epub 2010 May 21.
Egrilmez S, Aslan F, Karabulut G, Kabasakal Y, Yagci A.
Source
Department of Ophthalmology, Ege University Medical Faculty, Bornova-Izmir, Turkey. saitegrilmez@yahoo.com

[MikefromsouthNZ]

Hi Rebecca, I'm seriously thinking of asking for punctal plugs to help retain more tears/moisture to lubricate my eyes.. I was told that smart plugs were easy to keep in and more comfortable under the eyelids. What type of plugs would you recommend as I won't be able to fix or press them back into place if a plug tries to move..? I'd be grateful for any feedback please.. Mike

[Rebecca Petris]

Hi Mike,

You might want to try a dissolvable intracanalicular plug. Try contacting our moderator "IndRep" - he knows far more than I do and is a good resource for info.

The main distinguishing characteristics of plugs are
(a) punctal vs intracanalicular (punctal is usually visible, so you always know if it's there or not and they can be removed easily if necessary - but they can be less comfortable depending on fit etc; intracanalicular can't fall out though they may flush through, so there's generally less loss of that kind)
(b) durable vs dissolvable (this really only applies to intracanalicular types since punctal types are almost always silicone. no plug is risk-free but there are mishaps that happen to durable plugs that cannot happen with polymers)

Hope this helps.... by the way usually if a plug moves, it's gone, so putting it back in place by ourselves is not so much an option anyway. But where the delicate tissue of the eyelids and the nasolacrimal ducts are concerned, personally I think it's best to be conservative and risk-averse. It's not that the complications are frequent, it's just that if they do happen to you, they're ugly.