Dryness has returned months after plugs put in

[Súil Eile]

I had plugs inserted back in November, and there was an almost immediate relief from extreme dryness. My eyes were still dry, easily irritated etc; but the extreme 'desert-dry' feeling had gone. For example, I could put eyes drops in before going to bed and not have to put them in again til the next morning.

But in the past month or so the previous level of dryness has returned. Now I have to put drops in throughout the night, and my eyes are very uncomfortable first thing in the morning and throughout the day.

Has anyone with plugs noticed that the effect wears off after a while? I have an appointment with my opthaologist next month, but I'd really appreciate feedback from other plugs patients.

[irish eyes]

I'm not the best one to respond because plugs didn't suit me at all.

I recall things being marginally better when I initially had the 2 lower puncta done but then the consultant thought I would be better with the top 2 done as well. I readily agreed because I was in such discomfort

I went on to have huge problems because there was so much debris trapped in and around the eye (I have posted on this a few times already). They made the eyes wetter but not in a good way; lots of cysts and swellings.

I now only have 2 in the upper puncta and whilst it's not ideal, things are more manageable.

[bvendig]

dryness after plus

Hi
i have both upper and lower plugs and although it does help, i still have periods where it's dry again...and then periods that are better.
i think, in my case, i was giving FML because there was sort inflammation and that helped.
thanks, betty

I had plugs inserted back in November, and there was an almost immediate relief from extreme dryness. My eyes were still dry, easily irritated etc; but the extreme 'desert-dry' feeling had gone. For example, I could put eyes drops in before going to bed and not have to put them in again til the next morning.

But in the past month or so the previous level of dryness has returned. Now I have to put drops in throughout the night, and my eyes are very uncomfortable first thing in the morning and throughout the day.

Has anyone with plugs noticed that the effect wears off after a while? I have an appointment with my opthaologist next month, but I'd really appreciate feedback from other plugs patients.

[manitobaskyline]

I have been wearing plugs for 18 years. I am wondering what type of plugs you have. Are they the ones that don't have a cap on the outside? The ones I am referring to are placed inside the punctum and they expand inside there. Those didn't work for me at all because my punctums were too large and these type of plugs didn't fully block the opening so tears were able to drain down.

18 years ago I started with only lower punctum plugs. They helped marginally but I was never truly comfortable until all 4 were plugged. The other experience I have had over the years is punctum plugs that are too small. They diidn't fit snuggly and therefore some of the tears were able to drain from my eyes.

I have not found in my experience that plugs wear out. Like I said, I had problems with the intracannular??? plugs. I remember at first, they helped a lot, but eventually, they may have fallen through or some how dissolved more in my punctum and all the sudden I was dry. We replaced them with the regular capped plugs and I was fine again. I don't recommend those type of plugs because you never really know if they are still in. I prefer plugs that have a cap that you can see on the outside of your eye. Hopes this helps in some way.

[Súil Eile]

Thanks for all the replies! I have smart plugs, that are inserted down into the puncta with no cap on the outside. I just have them in my lower puncta. I don't think they've fallen out, as I can still feel them when my eyes are very dry or when I turn my head a certain way.

I guess, as with all treatments, I'm just going to have periods of increased dryness every so often. I'll be back at the opthamologist in a couple of weeks so hopefully he'll be able to sort something out. Maybe, as Manitobaskyline suggested, they may not be completely plugging my puncta. But I already have an issue with dry nasal passages as a result of the plugs....so it's catch 22 whether I want them to completely seal my puncta or not! Why is there never a simple answer for these things?

[y-gwair]

Just to clarify, do you just have a sensation of them being drier, or can you actually tell that they are? I find that the sensations of 'dryness' don't always match how moist the eyes actually are, but rather tend to match the degree of inflammation on the eye surface (usually matched by lots of small red veins flaring up).

I didn't find my plugs made the eye surface feel any more comfortable to begin with. Even though the staining and tear film improved dramatically within a month, the dryness sensation actually got worse until the ophth prescribed steroid drops to control the corneal inflammation and papilliary conjunctivitis. Since then, the corneal irritation has been better on the whole, veins only flare up occasionally, but the lid swelling/blepharitis has got dramatically worse unfortunately.

I've also found my right sinus feels permanently blocked/runny since the plugs, I wonder if it's just irritated by inflammatory substances or bacteria draining away from the eye (the right eye is always more inflamed and swollen than the other one).

[Súil Eile]

Diolch, y-gwair,

Although I haven't been to my opth since I had the plugs in, and therefore don't know how the plugs would affect any tests, I do believe my eyes are actually drier. There are fewer occasions where I can feel tears on my lash line, and they are feeling drier in general (particularly in the morning).

Your post has made me think about whether or not I've noticed any other symptoms, such as inflammation and irritation. Lately, my eyes have become more sensitive and that burning sensation has returned. I've also had over-tearing for the first time in a while. My opth had sucessfully treated my bleph with Vividrin drops, so I've decided to try these drops again for a couple of weeks in case my bleph is returning. The affects of bleph would explain the increased dryness of late!

I'm a little concerned now that any bacteria associated with possible bleph could be prevented from draining away from my eye due to the plugs.

Sinus issues seem quite common in people with plugs, although I haven't been able to find anything written on it. Another question for my opthamologist!

[y-gwair]

Your post has made me think about whether or not I've noticed any other symptoms, such as inflammation and irritation. Lately, my eyes have become more sensitive and that burning sensation has returned. I've also had over-tearing for the first time in a while. My opth had sucessfully treated my bleph with Vividrin drops, so I've decided to try these drops again for a couple of weeks in case my bleph is returning. The affects of bleph would explain the increased dryness of late!

This has been my problem I think, the degree of discomfort/dryness sensation seems to correlate more with signs of eyelid inflammation, rather than dryness per se (my 'drier' left eye feels better than the right which has more MGD symptoms). I've never found that using celluvisc made any difference to sensation of dryness at all; gradually the MGD seems to be emerging as a greater problem.

Has the ophth really not seen you since the plugs were fitted? Mine had me back after about a month to evaluate their effect, check they were still secure etc.

[Súil Eile]

Has the ophth really not seen you since the plugs were fitted? Mine had me back after about a month to evaluate their effect, check they were still secure etc.

I was a bit suprised by this too, but he said that there would be no indication of long term effects of the plugs after just a month or so. And I can kind of see his point, as a month later my eyes were feeling great, but I'm having issues now. It was a bit daunting at the time though to have no appointment made!

It's interesting that your eyes can feel drier than they actually are. Is this possibly because, out of all the sensations we can feel in our eyes, dryness is the one we can identify most easily and therefore becomes a default sensation?

[y-gwair]

I was a bit suprised by this too, but he said that there would be no indication of long term effects of the plugs after just a month or so. And I can kind of see his point, as a month later my eyes were feeling great, but I'm having issues now. It was a bit daunting at the time though to have no appointment made!

I got the impression that mine was probably expecting there to be further issues, as she didn't hesitate to suggest a further course of steroid drops. If you're having problems I definitely try to go back and pursue it. The trouble is we can't actually see what's happening to our eye surface, whereas they can use fluorescein, dyes etc to evaluate the eye surface and quality of the tear film.

It's interesting that your eyes can feel drier than they actually are. Is this possibly because, out of all the sensations we can feel in our eyes, dryness is the one we can identify most easily and therefore becomes a default sensation?

Interesting. Its so difficult to tell and very subjective. I had long-standing dry patches on my drier eye (acc. various opticians and ophth), but felt no additional discomfort on that side at all, but that might be because I have reduced corneal sensation after 25 years of dry eyes. The discomfort that prompted me to seek help was what has turned out to be MGD in the right eye (plus the unexplained aching/oedema).

My eyes felt subjectively much 'wetter' whilst taking steroids so some of that sensation of dryness must have been due to inflammation, as technically, the eye surface and tear film were much improved before that point. At the same time, the lid problems got rapidly worse and it became easier to distinguish which kinds of discomfort related to the different parts of the eye. I think most of it now is lid related, but this can somehow 'leak' onto the cornea and set the inflamed veins/burning sensation off I'm finding (stepping up lid hygiene helps arrest it before it gets that far), but it was very hard to tell the difference before I'd gone through all the various interventions.

[Súil Eile]

Just an update - my eyes got because the plugs fell out Guess as a plug newbie I was expecting them to last longer than a couple of months. I got the replaced on Friday, so fingers crossed these last longer! I'm completely paranoid about going near my eyes now as I'm afraid to knock them out. That's probably a good thing though, as it'll stop me messing with my eyes so much.

The proceedure back in November was a bit uncomfortable, but this time round the nurse completely drowned my eyes with anaesthetic drops (I was worried my ears would go numb with all the drops trickling into them!). So the proceedure didn't hurt at all, but since Friday my eyes have felt very 'bruised'. I've been putting ice-packs on them to help ease the discomfort and they are settling down now. I think the opthamologists did a bit of rooting around in my tear ducts, so they probably need some time to recover.