punctal plugs - how long before they 'work'?

[y-gwair]

I had plugs inserted about a week ago, and so far have felt no benefit at all. Just out of curiosity, if you have plugs, how long was it before your eyes started to improve (if at all)?

The ophthalmologist wants to see me after I've had them a month (and to keep up a regime of simple eye ointment at night, various tear substitutes by day), but if anything my eyes seem even drier and more uncomfortable since I had them fitted.

[irish eyes]

Punctal plugs

I wasn't too bad when I had 2 plugs but problems kicked in when I had the other 2 done. The eyes were wetter (with what was like dirty washing up water) but the trapped bacteria caused nasty cysts along the eyelid margins. It was a truly horrendous time.

Thankfully, one of the lower plugs fell out and hospital staff removed the other one shortly afterwards. I still have the upper punctal plugs which seem to get irritated occasionally but nothing major.

My consultant wants me to reconsider the full punctal plug option but I'm adamant not too. They don't suit everyone - but maybe you should give them a fair trial before you decide they're not for you.

[y-gwair]

Thanks, I guess I am worried that that they may be irritating the eye surface, as the discomfort is worse on the inner edges of the eye, difficult to tell as they were so irritated before.

Rapidly coming to the conclusion that this may be a flare of Thyroid Eye Disease, as the discomfort doesn't seem to be correspond to dryness (especially as the plugs seem to be making no difference). I hadn't realised that TED can occur in hypothyroidism (thought it was just a complication of Graves Disease), but the Moorfield's ophthalmologist said it did occur rarely with underactive thyroid disease, and was shocked no one had mentioned this, or checked me for it before. She measured my eyes for any change of shape, but reading up since my last appt, TED can account for all the symptoms I've been suffering, plus the flaring/remission pattern of discomfort.

[jenny2008]

what type of plugs did you get? permanent or dissolvable? ones with caps or smart plugs???
as soon as i got plugs i felt relief. i have sjogrens though and the past month i overtear constantly but i rather do that then be dry..that is the worst and most painful...

[y-gwair]

Permanent ones, no idea which type she put in though. I haven't had any overflow of tears at all.

I have undifferentiated connective tissue diseases with sicca syndrome (in addition to the thyroid disease) for which I take plaquenil/hydroxychloroquine; my memory of Sjogren's boards is that most people get fairly immediate relief with plugs (if they stay in), which makes me think there's something else going on other than just aqueous deficiency.

Eye... abnormalities common in people with underactive thyroid disease

[kitty]

It took about two weeks for me to see maximum benefit, which was little more than allowing the artificial tears to stay around a little longer. My eye allergy symptoms increased with two plugs and even more with all 4.

[y-gwair]

Eyes really bad today, aching all over, and really stiff and sore to move left-to-right; and the right eye is noticably difficult to focus. There is soreness now on both inner and outer extremes of the eye, which makes me doubt whether it's connected with the plugs. The aching feels similar to that when you press your palms into your eyes with firm pressure. Dryness might be better, I can certainly keep my eyes open for longer without blinking, which might suggest the plugs are 'working' to some degree, but this isn't having much effect on the overall discomfort.

[y-gwair]

Just to update, when I had my follow up with the ophthalmologist 5 weeks after the plugs went in, she said they had greatly reduced staining, restored tear film, increased TBUT etc, but that the surface of the cornea was still very inflamed, with papilliary conjunctivitis, and put me on steroid eye drops (Maxidex). These haven't worked as well as I'd hoped, but a lot of the problems now appear to be due to sensitivity to the various lubricants/preservatives etc building up in my eyes. Plugging certainly seemed to exacerbate the build up of irritants, but at least I'm more certain about how much of a problem this is now.