anyone tried permanent plugs aka "smart plugs"?

[willwork4tears]

Hi everyone. (To those that "know" me - sorry for the several month hiatus. I started a new job and have been pretty much swamped since April.)

So I'm considering getting the "Smart Plugs." I've had the "permanent" silicone plugs before, but I couldn't tolerate them because I have inward-turning puncta (they turn in towards my eyeball, not up towards the upper lid margin). This caused the plugs to rub on my eyeball and made me want to climb the wall. I tolerated them for a couple days thinking eventually I would desensitize and "get used to them." After 3 days one of the "permanent" plugs fell out on its own. Ahhhh sweet relief (at least 50% of the way). I tolerated the other plug for another day or two, then couldn't take it anymore and extracted it myself with tweezers.

I've had the dissolving/collagen plugs and LOVED THEM! I felt the best I had felt in over 5 years. The only problem is they dissolved in two months. I don't have the time/money/patience to go to the doctors office every 2 mo for plugs.

The doctor told me I could have cautery, which I tried and it turned out miserably. He couldn't get me numb, so I couldn't tolerate the searing pain and it was impossible to get a complete cauterization. His other options for me were to book an O.R. and either 1) try the cautery again (under propofol) or 2) consider having the puncta surgically cut out and sutured closed (I couldn't tolerate silicone plugs...how am I going to tolerate stitches rubbing on my eyes for 2 weeks????) or to have Smart plugs put in.

So has anyone had the Smart Plugs and can offer some input on what they think?

Thanks!

[indrep]

I would look into the OASIS Form Fit first. A Google search has shown the Smart Plugs to have some issues. They can be difficult to remove and there have been a number of complaints regarding granulomas and dachrocystitis.

[willwork4tears]

anyone tried Oasys form fit?

Thank-you. Yes, the doctor discussed the possibilities of granulomas as well as canaliculitis as well as the difficulties of removing them. The manufacturer says they can be flushed out, but the literature and the doctor indicated that many times flushing is unsuccessful and then they must be cut out.

Has anyone tried the Oasys form fit plugs???

[willwork4tears]

Well neither of my doctors have used the Oasis Form Fit plugs. Unfortunately, nobody has popped up in the last week or so raving about their Smart Plugs. And after reading some negative feedback (older posts) and seeing some negative case-reports in the literature, I have decided not to move forward with permanent intracanicular plugs. Maybe if I had dry eye due to lasik or other reasons I would consider. But having Sjogrens, who knows how my hyper-active immune system will tolerate a permanently placed foreign object.

Here I go again with cautery.

[Guest]

Good luck with the cautery! Hopefully it works for you! Are you going to get them to put you under for it since they couldn't numb it last time?

[willwork4tears]

Hi SAAG,

Yes, I have to have it done in an OR so an anesthesiologist can give me propofol (i.v. sedation). It should go much better this time. No searing torture.

I keep reminding myself of how happy you were with your cautery and how much it helped you. I remember you saying you had tears spilling out and it was so wonderful to have tears even if it was a few too many. So I'm keeping heart that things will be easier this time. Hopefully, in the end I will be happy with the result and my decision.

[Guest]

Well, I like the fact that with cautery the worst thing you have to worry about after everything is all healed is overflowing tears.

No worries about foreign body reactions to the plugs... no worries about intracanicular plugs getting lost in there and doing harm... no worries about plugs scratching the eyes... I'm a huge fan... what can I say? Carrying a tissue around is a small price to pay for the increased comfort.

(Now if I could just get my darned left eye to start tearing more like my right eye, I'd be a REALLY happy camper.... if it weren't for my left eye, I wouldn't need to wear moisture chamber glasses at all... )

Anyhow, I'm sure everything will go great with your procedure! For an ophthamologist, cautery must be one of the easiest surgeries they do! Let us know how it goes!

[Ariel]

Please keep us posted and let us know how your eyes are responding. I'm considering having the same procedure. I take it that expressing your glands once or twice a day never worked you either one of you.

[jenny2008]

i have smart plugs... no problems with them.. they are great for the upper ducts-because mine too rub against my eye and i cannot tolerate the umbrella type there.. for my lowers i have both smart and umbrella plugs--the smart plugs don't seem to catch 100% of tears as the umbrella ones do..

as far as issues.. i have been warned by many docs not to get cautery.. esp the fact that Sjogrens can go up and down and into remission. last year i overteared all the time and had about 9 months of feeling pretty darn good... since than it has been a struggle.. i have been dealing with this since march of 07... my point is that sjogrens (at least with me) has periods of not so bad and periods of flare ups and more dryness.. etc....

[Ariel]

Jenny-- I guess if tear production fluctuates in the way you described it must be an entirely different situation.

[willwork4tears]

My dry eye from the Sjogrens doesn't seem to wax and wane. It's just getting progressively worse.

My main eye dr. won't use the smart plugs (due to lack of experience using them). He sent me to someone else who would put them in, but he turned out to be a slimeball. I won't let anyone I don't trust touch my eyes! So that's why I decided to due the cautery. If something goes wrong or I need to have it reversed I know my original eye doctor will do everything in his power to make it right. Dr. Slimeball, however, would probably just tell me to suck it up or go back to my original doctor and make him clean up the mess.

My surgery is Tuesday, September 28....so now I play the waiting game.

[Ariel]

Staying away from Slimeballs is good thinking. Sadly there's too many of them around.

Good luck with your surgery! Please keep us posted.

[willwork4tears]

Finally had my CAUTERY!

Well friends, here's the update!

Since I decided against the SmartPlugs, I had punctal cautery instead. My surgery was yesterday AM (performed under propofol sedation). I'm back at work the next day and in no pain or discomfort. I feel about 95-99% normal. The only issue I'm having is a little foreign body sensation if I look to the side and then blink. If I look straight ahead and blink it feels normal.

The puncta are flat and white. They kind of look like tiny white second degree burns. There's no raised blister or obvious signs of swelling.

And the good news is my eyes feel moister already!

[indrep]

yay! congratulations

[hopingforacure]

Hi !

Hope you continue to do well!!!