Comparison: 2 plugs to Quad plugs

[skeeter70]

I currently have plugs in my lower lids (which I got 1 month ago) and have been on Restasis for 3.5 months. My doctor was reluctant to plug me at all during my last visit. I think that he thought I might eventually get overflow tears with the Restasis use. However, I do not feel anywhere near overflowing. Actually, I feel like I need more plugging. While I am experiencing more better days, the bad days are still a pain. Does having quad plugs help significantly in comparison to having only lower plugs? I am contemplating calling my doc for an earlier appointment and asking about getting these. Any advice out there would be appreciated.

[indrep]

Skeeter ask your doctor about 90 day plugs and Flow Through plugs. The first would give you an idea of being quadra plugged with the knowledge that in 90 days they would be gone and the second can occlude a little more tear with the option of removing them and going with total occlusion.

[nitrodrops]

Any folks experience differences between 2plugs and 4plugs?

I have 2 lower plugs inserted, felt a marginal improvement, not tremendous though. Thinking should i go for another top 2.

[spmcc]

Two plugs did nothing for me (tried over and over for 15 years).

Four cauteries worked best for me.

[nitrodrops]

Hi SPMCC,

Just curious, with 4 cauteries, have you experienced any dirts trapped causing infections?

This is what i am worried about having 4 plugs.

Cheers

[spmcc]

Just curious, with 4 cauteries, have you experienced any dirts trapped causing infections?

This is what i am worried about having 4 plugs.

Maybe I'm an odd case, but I've had no issue with dirt, mucus, crud, infection etc. when all four punta are sealed.

If you're worried, take baby steps. Try dissolvable plugs in the uppers (leaving your permanent plugs in the lowers). You could even start with 10-day dissolvables.

Also double-check that your lower plugs are still in there! Sometimes people have a good result with plugs and then, abracadabra, it disappears. It could be because the plugs have popped out!

Good luck.

[nitrodrops]

Maybe I'm an odd case, but I've had no issue with dirt, mucus, crud, infection etc. when all four punta are sealed.

If you're worried, take baby steps. Try dissolvable plugs in the uppers (leaving your permanent plugs in the lowers). You could even start with 10-day dissolvables.

Also double-check that your lower plugs are still in there! Sometimes people have a good result with plugs and then, abracadabra, it disappears. It could be because the plugs have popped out!

Good luck.

Thanks for your suggestion. Unfortunately, only permanent ones are available. Will give it a try, worse just take them out.

[Ahmed]

I think patients need to get things into perspective, I have fitted 100+ plugs, and only removed a single plug due to possible infection.

regards,

Ahmed.

[littlemermaid]

Ahmed, I can see your point but some people here have aetiologies other than post-LASIK that have infection or reactivity risks - chronic ant/post bleph, seb bleph, immune response like hypersensitivity and swelling or worse, unidentified sinus problems, so there may be hesitancy from causes you wouldn't see normally. Eg LM has lower plugs, good, but on reinfection of MGs tear film goes toxic and the surface is in trouble. We have this under control but infected canaliculi would be difficult due to hypersensitivity to oral antibiotics.

[Ahmed]

Ahmed, I can see your point but some people here have aetiologies other than post-LASIK that have infection or reactivity risks - chronic ant/post bleph, seb bleph, immune response like hypersensitivity and swelling or worse, unidentified sinus problems, so there may be hesitancy from causes you wouldn't see normally. Eg LM has lower plugs, good, but on reinfection of MGs tear film goes toxic and the surface is in trouble. We have this under control but infected canaliculi would be difficult due to hypersensitivity to oral antibiotics.

Hence plugs should only be used when indicated, rather than a trial and error process etc. I would not use plugs in some of those situations you have mentioned.

Regards,

[littlemermaid]

Aha.. you think that 'till you meet eg the patient with non-obvious systemic causes like sun-sensitive skin. Indicated or not? People here are difficult cases.

[spmcc]

I think patients need to get things into perspective, I have fitted 100+ plugs, and only removed a single plug due to possible infection.

I've had tons of plugs over 15+ years. I've even had multiple dissolvables put in one puncta (the sizes for the 3-month dissolvables are smallish for me... so I figured if I kept adding more plugs they would add up to create a complete blockage!).

Anyway, it wasn't until I got intracanalicular plugs that I got an infection. I had some put in my lowers and everything was fine. Six months later, I got them put in the uppers. Voila, insta-infection. You could milk my upper puncta (seriously, you could push on the canaliculi and white liquid would come out).

I got them flushed with saline and vigamox and it cleared up as quickly as it arrived.

So, I am not anti-plug. I am just pro-baby steps - especially for some people who tend to worry. I personally have never bought into the "toxic soup" theory.

[littlemermaid]

LM has toxic soup during a flareup. The eye surface goes reddy-golden. We blitz with antibacs, steroid and tear substitutes. But plugs have been a god-send in saving the eye surface by maintaining tear film. Thanks for info about flushing, spmcc, we'll be needing that one day.

[spmcc]

LM has toxic soup during a flareup. The eye surface goes reddy-golden. We blitz with antibacs, steroid and tear substitutes. But plugs have been a god-send in saving the eye surface by maintaining tear film. Thanks for info about flushing, spmcc, we'll be needing that one day.

I don't really have flare-ups of rosacea. My rosacea is every day constant. So LM and I seem to have different manifestations of the same condition.

Just another thing to think about... I don't know that steroid drops are good for active infections... for inflammation, yes... but infection, no. So if there is active infection, finding the right antibiotic drop should be the goal. (someone please correct me if I'm wrong).

Also, flushing is for intracanalicular plugs, not permanent silicone type. Those can just be grabbed and pulled out.

[Ahmed]

I've had tons of plugs over 15+ years. I've even had multiple dissolvables put in one puncta (the sizes for the 3-month dissolvables are smallish for me... so I figured if I kept adding more plugs they would add up to create a complete blockage!).

Anyway, it wasn't until I got intracanalicular plugs that I got an infection. I had some put in my lowers and everything was fine. Six months later, I got them put in the uppers. Voila, insta-infection. You could milk my upper puncta (seriously, you could push on the canaliculi and white liquid would come out).

I got them flushed with saline and vigamox and it cleared up as quickly as it arrived.

So, I am not anti-plug. I am just pro-baby steps - especially for some people who tend to worry. I personally have never bought into the "toxic soup" theory.

I dislike plugs that allow pooling in the canilicula, I prefer the plugs that fit close to the puncta (drain entrance) itself, as pooling of fluid is an infection waiting to happen.



If you look at the diagram, you can see some plugs fit quite far into the canilicula, allowing the tears/mucus to pool. Some brands are better than others etc.

regards,

Ahmed.