plugs causing dry eyes

[jcorbett]

Has anyone ever heard of a study that showed that plugging your eyes could cause dry eyes to be worse after plugged? I think it has something to do with a theory that plugs cause eyes to be moister, therefore telling the eyes to stop making as much moisture and when plugs are removed the eye doesn't return to the pre-plug moisture levels.

[Scout]

Dry Eye: To Plug or Not to Plug

This article, from April 1999 Review of Optometry doesn't answer your question specifically about the long-term effects of plugs, but it does have some very interesting information about punctal plugs and the diagnostics that a doctor should perform BEFORE plugging. It also mentions the theory that you may be referring to.

Excerpts:

Punctal occlusion can be effective when aqueous deficiency is the root cause of pathological, or "bone," dry eye. However, this approach may not always be the answer for marginal dry eye symptoms.

The true cause of marginal dry eye is often something other than tear film problems. The three things I look for in marginally dry eyes are lid disease, lid disease and lid disease. I can't emphasize how important this is.

In a 1990 study Jerry Paugh and I found that more than 40 percent of contact lens patients with dry eye had meibomian gland dysfunction.1 Lid disease requires treatments such as lubricants, ointments, lid scrubs, sometimes temporarily discontinuing contact lens wear, and prescribing oral tetracycline or doxycycline. Punctal occlusion will not resolve these problems, but there are doctors who will reach for plugs before doing anything else. Resolving the lid disease is critical if the patient wants to continue wearing contact lenses (and that's usually the case). Avoiding the "plug first" mentality improves your chances of properly treating the patient.

There may be a couple of explanations for this. The "closed-loop" theory, put forth by Todd G. Slusser, O.D., Alan Tomlinson and Gerald Lowther, O.D., says that the eye may adjust its tear production after occlusion.4 In an eye that's aqueous-deficient, the body's own feedback mechanism interprets that as the normal baseline. If you put a plug in that eye, this feedback system tells the lacrimal gland that it is overproducing tears, so it cuts back tear production.

There's also the "cesspool" theory put forth by Art Epstein, O.D. This holds that the eye is designed for a natural river of tears to flow from the lacrimal glands, over the cornea and then drain into the puncta. If you plug the puncta, you are clogging the drains, so to speak. Tear preservation becomes tear stagnation.

[Kyle]

Wow, that was some really interesting information, because my left eye is plugged on the bottom and it is the worst eye. I'm going to print out that information and take it to my eye doctor tomorrow.
Also, when I tried Dakrina and Dwelle my left eye reacted very strangely (I've been e-mailing Dr. Holly back and forth to try and understand what happened).
That is the second time I have heard that a plug may actually make the eye dryer, but I'm starting to believe that may be what's going on with me. They immediately plugged my eye when I said something was wrong right after the surgery, but maybe that wasn't what I needed.
Thanks to all of you who always update us with new information!

[Gaye]

Drier eyes with plugs

Last week I had my upper right plugged (already had the lower plugged) and found I couldn't stand the constant tearing. My eye also felt worse than before. I went back yesterday to get the upper plug removed, and my doctor told me that my right eye was now actually drier than the left, which was only plugged on the bottom. I think the constant tearing washed away the good tears I might have had. I am glad I had the plug removed. My eye actually feels better today. But I am also glad I tried it, because now I know that is not right for me.

[Kyle]

I actually copied the article on the plugs and brought it into my dr here in LA. He, and his assistant, said there is no eveidence to support that this is true.
They would not take my plugs out based on this either.

I also asked about Soothe eyedrops and my dr said they are all basically the same. If I was on Restasis he said I didn't need to use Soothe.

One thing that did surprise me though was they said that patients with MGD and blepharitis (both conditions which are causing my dry eyes) are not in danger of further eye conditions down the road. According to all the research I have done I thought we were more susceptible to eye ulcers, cornea problems, cateracts and other things. What do you all think?

One other quick question (this should probably go under another thread, but since I'm already here...)
I have been doing everything to get the blepharitis to go away (bacitrin ointment, erythromycin ointment, lid scrubs with saline solution, hot compresses, restasis, etc...) and nothing is working! What else do you'all suggest? Does ANYTHING really make it go away!?

[jcorbett]

plugs - Kyle

As far as your docs saying there is no evidence to support it, there is probably truth to that. There are a lot of studies done, and some will contradict other studies. Just because you read it somewhere out on the internet does not make it so. While the internet is a fantastic source to gather information, we must be very careful not to jump to conclusions. That is the only source I have been able to find that mentions that theory.
Plugs have certainly been helpful to many people. They have been to me. I wouldn't necessarily think they are bad based on that article. My opinion, anyway.