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I thought I’d post an update since I’ve been feeling a little better lately. On May 11 I had a .5mm Superflex EagleVision punctal plug inserted in the lower left tear duct. I didn’t see any noticeable difference at all. On the 17th I went back and convinced the doctor to plug the upper punctum as well. He preformed the dye in the eye and blow your nose test to see how much the left eye was still draining. I was able to blow dye out after about a minute so he put a Superflex plug in the top too. Now I have no drainage in the left eye and it’s wonderful. I went from using 12-14 vials of Theratears per day to using just 1 or 2. Keep in mind though that for most people one plug in the lower duct will probably work just find but I have some unusual circumstances so two plugs works better for me.
I still have pain in the left eye daily but it’s not as bad as it was before and I think it’s possibly a pulled muscle, not dryness related. The right eye still gets dry/irritated at night so I’ll probably look into getting another plug or two if it doesn’t improve.
I’m still on Restasis. It’s been about a month and a half now. Doesn’t really seem to be doing much except taking 30 minutes out of my day but my dry eye probably isn’t due to inflammation so I’m not expecting much.
I also discovered that what I thought might have been some sort of viral infection on the under part of my upper eyelid was actually lid wiper epitheliopathy which I haven’t had any problems with since I had the punctal plugs put in the left eye.
Some tips if you’re getting punctal plugs.
1. In my opinion the anesthetic drops are pointless and do more harm than good. They didn'’t numb the tear duct area the first time and only made my eyes bloodshot/burn after the procedure. So this time I passed on the drops and the experience was much better. Plus if the plug feels scratchy isn'’t it better to know right away instead of when you get home?
2. It’s better to get a plug that’s a little too big than one that’s a little too small. I’d rather have a plug pop out than get stuck somewhere down the drain. The plugs they gave me are on the smaller size. The doctor says he couldn’t get the .7mm in but I was watching and I think he could have tried a little harder.
Update: I would say I agree with Indrep that a small plug has a better chance of working not a larger plug. Smaller plugs also are less scratchy in my experience since they have less of a profile and sit lower in the tear duct.
3. I don’t know if this was just in my case but I could see the whole insertion process by watching the reflection in the magnifying lenses they use to look at your eyes.
4. The easiest way to check if the plugs are still there is not to look for the plug but the look for the absence of the hole. In my right eye I can still see the dark holes of my tear ducts but the left eye they just look white, almost like they'’ve been cauterized.
5. Be mindful of where your plugs are located. These things are expensive ($125 a piece for me and mine were cheaper than most.) If you’re going to lose a plug it’s probably going to be your fault. So don’t rub your eyes, be careful washing your face and just dab lightly with the towel when you dry.
Update: After 6 years of having the same plugs I do rub my eye every now and then an the plugs seem to be pretty set in place so I wouldn't worry too much about dislodging them if they are a good fit.
6. If your plugs are scratchy try dabbing some Refresh PM in the area and make sure you keep your eyes wet. If they’re really scratchy something’s not right and you should go back to the doctor if things don’t improve over a few days. Personally I had hardly any scratchiness at all and can only feel the plugs if I’m blinking them directly over my cornea.
Update: Now I would say that if your plugs are fairly scratch there is a good chance that you might need smaller plugs. Or possibly they were placed in low enough. Every plug I had that was overly scratchy fell out eventually and kept falling out.
7. Plugs come with risks. Everyday I wonder if I’'ll wake up with one of them missing and start some new horrifying experience on this journey with dry eye. If you'’ve had plugs for a few years it might be wise to look into cauterization.
Update: I think the risks are worth it. I've had two silicon capped plugs inserted too fair into the tear duct. Neither of them ever cause any real problem. My other two plugs have been in for 6 years and have never caused any problems.
8. Epiphora. Being double plugged in the left eye I do have some over tearing at times. However, I’m not putting in 2 dollars worth of artificial tears per day and the annoyance of having to tilt my head so a tear can drop a few times a day more than makes up for the pain/burning of dry eye.
Update: Over tearing really wasn't as bad as everyone made it out to be, especially in contrast to dry eye. When my eyes would get too watery I would just tilt my head so the tears would drain out towards my nose then wipe them away with my finger like I was cleaning "sleep" out from my eye that way my eyelashes wouldn't get wet. Also it only needed to be done every 1-2 hours but my eyes were never dry again.
I still have pain in the left eye daily but it’s not as bad as it was before and I think it’s possibly a pulled muscle, not dryness related. The right eye still gets dry/irritated at night so I’ll probably look into getting another plug or two if it doesn’t improve.
I’m still on Restasis. It’s been about a month and a half now. Doesn’t really seem to be doing much except taking 30 minutes out of my day but my dry eye probably isn’t due to inflammation so I’m not expecting much.
I also discovered that what I thought might have been some sort of viral infection on the under part of my upper eyelid was actually lid wiper epitheliopathy which I haven’t had any problems with since I had the punctal plugs put in the left eye.
Some tips if you’re getting punctal plugs.
1. In my opinion the anesthetic drops are pointless and do more harm than good. They didn'’t numb the tear duct area the first time and only made my eyes bloodshot/burn after the procedure. So this time I passed on the drops and the experience was much better. Plus if the plug feels scratchy isn'’t it better to know right away instead of when you get home?
2. It’s better to get a plug that’s a little too big than one that’s a little too small. I’d rather have a plug pop out than get stuck somewhere down the drain. The plugs they gave me are on the smaller size. The doctor says he couldn’t get the .7mm in but I was watching and I think he could have tried a little harder.
Update: I would say I agree with Indrep that a small plug has a better chance of working not a larger plug. Smaller plugs also are less scratchy in my experience since they have less of a profile and sit lower in the tear duct.
3. I don’t know if this was just in my case but I could see the whole insertion process by watching the reflection in the magnifying lenses they use to look at your eyes.
4. The easiest way to check if the plugs are still there is not to look for the plug but the look for the absence of the hole. In my right eye I can still see the dark holes of my tear ducts but the left eye they just look white, almost like they'’ve been cauterized.
5. Be mindful of where your plugs are located. These things are expensive ($125 a piece for me and mine were cheaper than most.) If you’re going to lose a plug it’s probably going to be your fault. So don’t rub your eyes, be careful washing your face and just dab lightly with the towel when you dry.
Update: After 6 years of having the same plugs I do rub my eye every now and then an the plugs seem to be pretty set in place so I wouldn't worry too much about dislodging them if they are a good fit.
6. If your plugs are scratchy try dabbing some Refresh PM in the area and make sure you keep your eyes wet. If they’re really scratchy something’s not right and you should go back to the doctor if things don’t improve over a few days. Personally I had hardly any scratchiness at all and can only feel the plugs if I’m blinking them directly over my cornea.
Update: Now I would say that if your plugs are fairly scratch there is a good chance that you might need smaller plugs. Or possibly they were placed in low enough. Every plug I had that was overly scratchy fell out eventually and kept falling out.
7. Plugs come with risks. Everyday I wonder if I’'ll wake up with one of them missing and start some new horrifying experience on this journey with dry eye. If you'’ve had plugs for a few years it might be wise to look into cauterization.
Update: I think the risks are worth it. I've had two silicon capped plugs inserted too fair into the tear duct. Neither of them ever cause any real problem. My other two plugs have been in for 6 years and have never caused any problems.
8. Epiphora. Being double plugged in the left eye I do have some over tearing at times. However, I’m not putting in 2 dollars worth of artificial tears per day and the annoyance of having to tilt my head so a tear can drop a few times a day more than makes up for the pain/burning of dry eye.
Update: Over tearing really wasn't as bad as everyone made it out to be, especially in contrast to dry eye. When my eyes would get too watery I would just tilt my head so the tears would drain out towards my nose then wipe them away with my finger like I was cleaning "sleep" out from my eye that way my eyelashes wouldn't get wet. Also it only needed to be done every 1-2 hours but my eyes were never dry again.
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