I went for it....

[juninho]

I had silicone (lower 2)plugs inserted in November 05 and remember asking
on the site how long before any relief.How long is apiece of string?Well I waited and waited and here we are in March and I now am feeling much more
comfortable about my eyes.I never thought I would feel ok about my eyes again but I am at present.Life feels much better.Regarding asking questions
I make a list and stick to it because I was sick and tired of being 'fobbed'
off with 'put the drops in,goodbye!!', which made me so angry.
Don't be afraid to ask anything.Any decent doctor will understand and
respond.
It's been a long road to get to this stage and I was resigned to never
having relief again so 'hang in there' things might just improve.
Btw drops and gels never seemed to give me any relief at all,plugs
have helped.
Best wishes to you all,
j (Graham,North East England,UK)

[Gaye]

Thanks Juninho - as I sit here, I want to pull the plug on my right eye myself. Every day I wake up thinking that this might be the day it finally stops irritating my eye, but no luck so far. It appears to stick up higher than the left and maybe that is the problem. I had to go to my optometrist today to get my glasses repaired and I asked him about this. He didn't understand why the ophthalmologist used the plugs he did and said he would not have used that type. So I wonder what to do next.

[spaniel]

I've had the silicone plugs and when it was "too high" it did cause irritation and had to be repositionned. This might be the case for you. I eventually had it removed. The "plus" part of the plugs with the head on them is that at least you can "see"what is happening.

[Gaye]

plugs

Hi Spaniel - that appears to be the situation with my right plug. I can see that it sits higher then the left and I will have to go in to get it fixed. You are right, at least I can see them and I know that they are where they are supposed to be (sort of anyway). The bad thing is that it feels best when I don't blink my eye much and then it doesn't rub. That sure isn't going to help matters either! Thanks for the input.

[juninho]

have you got any releif yet Gaye?
I guess i have been lucky with the plugs I had inserted as i have not
experienced any problems like you described.In fact I don't know they are there.The doctor put the wrong size in first 0.6mm and they kept springing out.size 0.4mm fit perfect and I have had no discomfort at all from the plugs.
My other bonus was that they were free (nhs).I nearly paid over 300 pounds
to have the same plugs fitted privately as I was desperate but stood back
and waited and boy I'm glad I did.
Hoe things improve soon for you.
Regards, Graham. j

[Gaye]

Plugs

Hi Graham - thanks for asking. Once I started on the Acular, I started to feel better. It brought the swelling down that was causing the one plug to sit too high and scratch the corner of the inside of my eye. Between the Lotemax and the Acular, things feel more comfortable and I think I might be able to keep the plugs in. Don't know how dry I actually am at this time (will find out later in the month), but it all seems better.

[kitty]

Update

Just a quick update on my 3/22 post. I am now about 5 weeks out from having permanent plugs put in my lower puncta. Today, my doc said he did not like how dry my eyes looked. Well duh, I thought to myself! My testing today found NO improvement. I will try Restasis again. If that does not work or if I cannot tolerate it, I will be having the other two punctum plugged. Thanks all for your support!

Courious, is there any way to get a constant infusion of TheraTears into my eyeballs? Anyone game to work with me on a patent for some sort of a device .....other than that created by the use of my thumb and index finger? Ha Ha, just kidding.

[Danny_]

Gaye and Kitty,

Firstly, your plugs should not be hurting you. I am quadra plugged and feel nothing in either eye. Secondly, the lower ones did NOTHING for me. I felt no difference whatsoever. However, when I put the upper ones in, it was a different story. After one day, a HUGE change. My eyes can look at the computer all day now without hurting. Btw, it doesn't take weeks for the tear film to change. Mine changed in about a week or earlier. It's just that I got an appointment a for a week later and it was then that they saw the tear film had changed. I will try to find out for you what kind of plugs I am using but like you said, they don't like to tell you stuff, mainly, I think because they are unsure themselves. I haven't had the horrible experience Gayle had though as my doctors are nice.

As far as I can see, there are two main causes for dry eye - not producing enough tears or losing too many through your punctua. I have both problems in that I only produce about a quarter of the normal amount of tears but these are more than enough when I am quadra plugged. What I would say to you is don't wait. If you have had the lower plugs for about 5 weeks, start by getting one of your eyes double plugged and get an appointment for two weeks later. Your other eye will feel very dry when you do this btw. Also, DO NOT get permanent plugs. You might as well get your eyes cauterized if you are going to do this as you cannot remove them except with great difficulty.

Good luck and I hope you feel better soon.

[kitty]

Danny, thank you for sharing your experience with the plugs. I noticed when I had all four plugged with the test plugs, I thought I was more comfortable for a couple of days until they dissolved. At present, I am only producing a scant amount of tears. The purpose of plugs for me is to keep every drop of moisture in my eyes that I can. My doctor has recommended that if Restasis is not for me, I should try the 6 month dissolving plugs for my upper puncta. After that, we will decide whether or not to go with "permanent" plugs. My eye doctor has the same kind of plugs that I do. He had one easily removed through irrigation.

While I appreciate your insight, and do not mean to offend, I am comfortable with my physician's treatment plan and recommendations at this time.

[SusieD]

Also, DO NOT get permanent plugs. You might as well get your eyes cauterized if you are going to do this as you cannot remove them except with great difficulty.

Can I just ask to clarify - are you saying you have dissolvable ones in your upper puncta and permanent ones in your lowers? Or are they all dissolvable and you get them replaced. Technically, no plug is permanent anyway, even the sillicone ones (although some experience difficulty with removal). Only cautery is permanent.

Can you see your plugs when you pull down your eyelid? or are they the kind that sit inside the canal (can't see).

Thanks.

[kitty]

I do not yet have plugs in my uppers. I had a short trial of plugs in my uppers but they dissolved within a few days. I have "permanent" lower plugs, the Herrick Intracanalicular (inside the punctum). These are blue, radiopaque silicone. I can see them slightly if I pull down my eyelid (in normal light). They are more easily seen if I pull down my eyelid and then put a pen light just below the punctum. That is the same way that my doc checks for placement, with a type of pen light.

[indrep]

Danny, plugs not the same as cautery

Danny,
I am glad that plugs are working for you.

Please know there is a huge difference in cauterizing a punctum and inserting plugs which are reversible. Once you cautrize tissue it is damaged forever. Punctal occlussion with silicone exposed top plugs can be reversed with no tissue damage. This assumes they were inserted correctly. Some peoples DES will go away if they stop using a medication that is causing the DES. Even some Rheumatoid patients will have a reversal if it is Juvenile RA. Permanent tissue alteration is a serious decision.

[Rebecca Petris]

Indrep, I am curious, in your experience what could be the downside of cautery specifically? Have you known people to end up with permanent epiphora or other problems?

[indrep]

Yes there are patients, including my wife, who had Schirmers of 0-1 and after being plugged for a few weeks in all four puncta she developed excessive tearing in one eye. Had it been cauterized she would have faced a surgical procedure. While this site has some of the most sever cases of DES I have ever seen, there are many cases where environment, medicines, diseases, birth control pills, menopause are the causesfor dry eye and when treatments or life changes then the Dry Eye situation is different. If you can help it you should never advocate tissue damage when there is less invasive or reversible procedure available.

[Danny_]

Can I just ask to clarify - are you saying you have dissolvable ones in your upper puncta and permanent ones in your lowers? Or are they all dissolvable and you get them replaced. Technically, no plug is permanent anyway, even the sillicone ones (although some experience difficulty with removal). Only cautery is permanent.

Can you see your plugs when you pull down your eyelid? or are they the kind that sit inside the canal (can't see).

Thanks.

They sit in the canal I suppose because I can't see them although I don't know. I don't know if they are dissolvable because they have not dissolved yet and I have had the lower ones for months. They are also very easy to remove (just takes about two mins). Likewise putting them back in is very easy (two-five mins).

My physician also told me that I could get permanent ones that cannot be removed so I am not sure you are correct about none being permanent. All I know is that these things have worked for me. I have never even tried to see the plugs though or pulled down my eyelid for fear of dislodging them. The trick to them is to get the right size. I started with size 6 in one eye and size five in the other but then changed to size 6 in both. They didn't make a REAL difference to me until I got all four plugged though so I would recommend that anyone with severe dry eye just goes for doing this. It comes with its own problem of possibly an overflow (the only reason I am posting here about my experiences is that I have that complication - otherwise, I would not be at this site - but now that I see others like me suffering, I wil stay and share my experiences.) Having an overflow though is about a million times better than having them dry and I am learning to deal with it and it does seem to be getting better with time.