Should I get permanent plugs?

[kitty]

My trial of temporary collagen plugs in all four punctum resulted in about two days of decreased use of artificial tears (maybe 30% less). I think I felt more comfortable, but still felt dry, had redness and still had some burning. These symptoms seemed less severe for those two days. I'm not sure if this was simply a placebo effect or not. I know that after the two days of increased comfort I was hit with a severe flare of burning, redness, dryness, etc. I'm fairly sure that my eye doctor will want to go ahead and insert the permanent Herricks. Should I go ahead with that or ask for a longer trial with a plug that dissolves in 3-6 months rather than 4-7 days? My other quandry is that this is allergy season, and I am experiencing more burning and itching which I think is due to allergies. It's really hard to sort out what is what. Any suggestions on what questions I should ask before agreeing to the permanent Herrick's?

[Delilah]

Permanent Plugs

Anything "permanent" is serious and should be very well thought out. Since I have read tons of peoples posts on many different problems with plugs I would reconsider the thought of having them put in permanent. In 3 months if my eyes do not improve I am thinking of trying the plugs, but having read so many horror stories is making me think twice. The eye is the most delicate of all on the human body, what if you get them permanent and then have trouble with them What will happen if an infection should occur or your eyes don't take to them? I am not trying to tell you what to do but if I were you I would try more plugs for a longer period of time and see how your eyes react to them. Even try them for years before you decide to have them permanently implanted. Best of luck to you. Delilah

[neil0502]

Is $$ an issue? If not, I'd get the longer-lasting temporary plugs.

I'm just not sure that too many people have really had major issues with their plugs. Some have had discomfort; some have had to have them replaced, or resized, but I think it's a fairly benign procedure that brings relief to many.

Also, bear in mind: "permanent" is a misnomer. Plugs can be readily pulled. Even the cauterization (what I have) can be reversed, though only surgically.

Move slowly. Move one step at a time. But keep moving forward on things that are helping you.

All the best,

Neil

[shells]

Hi Kitty,

I am in the process of making the same decision as you right now. I tried the collagen ones, then the 90-day dissolvable ones and did not get much relief. It has been about 3 months now, so I need to decide if I want to go with the permanent ones now to see if they will help. Aren't Herrick plugs the ones that go all the way down in your punctum, so you cannot see them? Maybe you've mentioned this already, but have you tried the other permanent kind that have the little cap on them yet? For some people they irritate their eyes worse because the cap scratches against their eye, but for some they are comfortable. And you can always keep track of them and tell if they are still there or not. They can also be removed if you decide you don't like them. Perhaps trying those first would be a good idea. That is what I am planning on doing I think. I personally don't like the idea of having a plug down where I can't see it, and possibly taking the chance of something going wrong with it.

-Shells

[kitty]

I am concerned about the Herricks, in that they are the intracanalicular (in the punctum) type. There was lots of bad press about them around 2001, but I have not seen any negative articles since. My eye doctor has them himself. I realize I need to do something to keep more moisture in my eyes or I will be having some serious problems down the road. I just wish they had given me more significant relief. I am welcoming all comments. I just want to make an informed decision. I guess there are risks to everything. We just have to decide if the benefits outweigh them. $$$ are not an issue. I just learned that my insurance pays 100%. All I am out is my $15 co-pay for each office visit.

[neil0502]

Well ... let me reach just a little further here....

From what I gather, the plugs are really only indicated if you have an aqueous deficiency sort of dry eye. If it's an evaporative dry eye (MGD, for example), you probably don't want/need plugs. It seems like the extra tears from plugging just make the soup thinner, increasing rate of evaporation.

Have you tried a product called Lacrisert??

http://www.merck.com/product/usa/pi_...rt_uspc_pi.pdf

They don't work (at least not well) with contact lenses, but if you don't wear contacts, you may want to discuss them with your doctor. They're teeny-tiny little plastic barrels that contain ... uh ... eye syrup that dissolves throughout the day, thickening the tear film and slowing evaporation.

Just my $0.02....

[kitty]

I have heard about Lacrisert but have not tried them. I used to wear contacts until the DES hit hard and heavy last fall, at which time I was told to stop wearing them. My doc's goal is to get me back in contacts. I got a long way to go for that.

[SusieD]

If you have never had permanent plugs before then I would try it - at the very least you will know if they dont suit/help you.

Personally (and this is only my opinion, based on my own experience) I have little time for intracannicular plugs - especially those one size fits all ones and have felt little benefit from them. Admittedly, I have never had the Herricks ones however I understand that they sit even further down in the canal and I would think it would be very hard to gauge how efficient they are. I am thinking of plugs again, my doctor thinks all four. However if I cant see the plugs, Im not that interested. I am hoping I will be able to get the Odyssey Parasol plugs because I have heard only good things about these. Not only from people on this board, including Dr G. but also from some one I know who has had them in place for over 2 years and they have helped her greatly. She has had other plugs before and find that these are the most comfortable - because of the tapered shaft around the edge of the plug (bit that sits on top).

As is always said by many on here......everything is worth a try.

Incidentally, I have both aqueous and evaporative problems, but still found that silicone plugs made my eyes more comfortable. (before it fell out!)

[Delilah]

My Dear Mrs. Kitty

Hello its Stringy D from Idaho LOL, thought I'd just throw in a little dry eye humor. About the plugs, my doctor had mentioned another eye procedure that I never heard of, he said that he somehow sews the sides of the eye to make them smaller so the moisture stays in, now I am not sure if that is on the inside or the outside? Have you heard of this? It sounds painful and scary but I should of asked him in more detail of what it was but anytime a doctor mentions surgery to me I start talking about the weather lol, I hate surgery as I have had so many and anything that has to do with my eyes I freak out!!!
Also what about that guy Adam? Member Adam, he was on here and had dry eye and something wrong with wrinkles in his cornea and had that Amniotic Membrane Transplant and last I heard he's doing good, but insurance will not cover that, but it seems to me that all of us who suffer from dry eye would probably benefit from this as it is healing our corena with new tissue, but $17,000 for both eyes with no insurance is harsh. And a question Kitty, do you think I should try the dissolving plugs? Im so afraid and will you please tell me how bad it hurts, can they do it with mild anesthetics? Im a complete baby when it comes to any sort of procedure.
I really hope that you make the right decision on what to do with your eyes and whatever you do I will back you up 100%, if you need to vent just give it here because you and everyone else on here sure has helped me. Lots of love from Idaho, the Potatoe State lol. Ciao D

[kitty]

Hi Delilah. Did I tell you that Idaho is my old stomping grounds? I graduated from ISU and spent 8 years in Pocatello, still have many friends there and know many of the docs too. I know Dr. Lawless. Back on topic. I think you are talking about tarsoraphy (not sure of spelling). They sew the corners of the eyes shut to help keep in the tears. I think that might be done more for people who tend to sleep with their eyes part open, or can't close them all the way due to neurological problems or injuries. The amniotic membrane transplant is something I would consider as a last resort, if I was facing vision loss due to erosions. I suggest you try the temporary collagen plugs. They can't hurt you. They really did not hurt going in, it just felt wierd and caught me off guard not knowing what to expect. My doc used anesthetic drops frequently. There were some times that I felt a dull poking sensation, but apparently I blinked when I did so the doc knew and he put in more drops. Like I say, it really was not "painful". The temporary plugs might give you some idea of how you will respond to the permanent ones. For sure they will let you know if you will experience epiphoria (tears running down your face) with the permanent ones. I think I have decided to trust my doc's recommendations. The plugs can be flushed out if I don't tolerate them. Right now, I am having so much discomfort from the neck up between the DES, allergy eyes and TMD that I will take whatever relief I can get! Thanks much for the support. I am here for you, too!

[sazy123]

Delilah: What do you mean when you say Amniotic Membrane Transplant can help most people with dry eye? i thought it only helped those who had a fold in thier cornea, which trapped tears. I am confused about this..

Susie: Can you get these odessey plugs in the UK?

[SusieD]

As far as I understand - the amniotic membrane transplant is only indicated if you have a 'wrinkled' conjunctiva - hence more surface area for the tears to cover, which they dont do when you have a reduced amount anyway. I dont think It is done unless you have this problem. Does make me wonder about how common a problem it really is though.

Re: Odyssey plugs, I have no idea if you can get them or not, havent been able to find out. I would think so, its just a case of ordering them, again depends on the doc though! There seems to be two types of docs where plugs are concerned - those that like the silicone plugs and those that like the intracannicluar plugs. Cant hurt to ask though.

[Delilah]

Amt

Hello everyone, I had read on an article that the Amniotic Membrane Transplant can reconstruct the tissue of the cornea, it is mostly for the wrinkles in the eye but as it sits on the eye it replenishes the corena and can heal it, I will try to find that article and copy and paste it Sorry for the confusion. I might try the plugs Kitty and I didn't know Pocatello is your old stomping grounds lol, yeah its still freakin boring as hell but it's my home. May I ask what you graduated in? May I also ask where you live now? I would love to move to a humid climate but I couldn't leave my best friend or my family. Ciao for Now D

[Delilah]

The Article

http://www.thehighlights.com/Merchan...de=15-Feb-2005

Here is the article I read about the AMT helping dry eye, along with many other things, this AMT is very helpful, but it too would be my last resort. Read the whole article, it really is interesting.

[Lucy]

Delilah-I just wanted to say that I've had at least 12 plugs put in. Some fell out, I pulled a couple out and who knows where the rest are? But, in all seriousness (is that a word?) I only had one insertion of a plug hurt. It was a pinch sort of hurt. They give you numbing drops in most cases.

For me, I found out the numbing drops left me with burning corneas for a couple of days after, so finally I just said "skip the numbing drops."

If anyone has had a painful experience, I believe them, but I did not. Except one time I winced a bit. Nothing as bad as a novicaine shot by the dentist!