Recommended Steps for Success with Puctal Plugs

[JoeB]

Hello,

My eye doctor recommended punctal plugs to help my dry eye. I've read quite a bit on this board, and it seems there are many routes and pitfalls.

I want to do this. Which is the best way? Which is the best, safest brands?

What are the steps, brands, and should they be temporary or longlasting that I should I go for.

Overall, I would like to go for something that is safe and longlasting. It doesn't seem to make sense (and it seems expensive) to have to go back over and over due to them being ill-placed or getting lost in the tear duct etc.

Please let me know whatever is best, even if it doesn't match what I desire.
Your advice is highly, highly appreciated.

Thank you.

[indrep]

There are two types of occlussion with plugs. The most common are silicone plugs that have a cap that rests on the pucntal opening. These are visible so you know if they are there or not. This cap also can contribute to them becoming displaced. When you wash your face or wipe the "morning goo" out of your eye can all be times when you inadvertently pull out the plug. Also some types of anatomy make this plug difficult to retain, slit shaped puncta, the lid margin facing the eye, etc. Also if they are not correctly sized and implanted you could lose the plugs. The good news most manufacturers now make their plugs out of a soft durometer material and have small caps for reduced opportunities at patient discomfort. I would stay away from the plug that has a tilted cap, some have reported that the plug will turn and the raised side of the cap becomes an irritant. The second type is intracanalicular. These are plugs that are implanted into the intracanaliculus. There are three manufacturers of these and they are all different. The first of these is the Herrick plug. It is a silicone golf tee shaped plug. It is blue and can be seen with transillumination. It has some reported issues and is no longer widely used. The second type is from Medinium, the Smart Plug. This is a temprature sensitive Acrylic material that shrinks in length and expands in diamter as it is inserted. It can not be seen with transillumination. This plug has gained popularity and the only issues seem to be some patients complain of foriegn body sensation and the removal of the plug can be difficult. The only other issue is insertion can be tricky but this is only an issue for the doc. The third is the OASIS Form Fit plug. This is a Hydrogel material that is 90% water when implanted and in its expanded state. It only fills the vertical space and due to the water content is less likely to dislodge or cause foreign body sensations. It cannot be seen with transillumination. If it needs to be removed it easier to irrgiate out than the other two in that it will come apart under irrigation.

In the end Joe you will ahve to talk with your doc and decide what is best for you in relationship to his experience with the different types of occlussion available.

[Lucy]

Thanks for the cogent "tale of the plugs" Indrep. It's really funny to know how something so "simple" can be so complicated.

[Flick]

Joe - you may want to try a temporary collagen plug first before you decide on more permanent options. I believe there is one type that lasts about 5 days, and one type that lasts about 90 days. They are both intracanalicular and dissolve away slowly, so there is less risk of infection or other problems. If you seem to be getting relief, then you could do the more permanent plugs or think about cautery.

Good luck!

[JoeB]

How long do they last?

Thanks for the answers! By the way, if properly fitted, how long do they last?

With so many lost, don't punctal plugs become expensive for the user? How much do they cost, generally?

Thanks for your help.

JoeB

[indrep]

Studies have shown when properly fitted, or sized correctly, plug retention at 12 months is 95%. This assumes the patient is properly instructed about caring for their plugs and doesn't pull them out by mistake.

Typically insurance will pay for a second insertion within 12 months. So you get plugs inserted and then 6 months later you need to have another plug inserted most insurance plans will pay. The third time gets to be a little harder to explain and get reimbursement.

[JoeB]

Swimming and Plugs

Studies have shown when properly fitted, or sized correctly, plug retention at 12 months is 95%. This assumes the patient is properly instructed about caring for their plugs and doesn't pull them out by mistake.

Typically insurance will pay for a second insertion within 12 months. So you get plugs inserted and then 6 months later you need to have another plug inserted most insurance plans will pay. The third time gets to be a little harder to explain and get reimbursement.

Thanks Indrep. Do plugs often last years if properly fitted?

Can a person go swimming? I suppost goggles should be worn.
If a person is doing heavy exercise and sweatting a lot, will they usually stay in?

Thanks a million.

JoeB.

[indrep]

Yes.

Swimming no problem, goggles if you like.

Yes, sweat won't bother the plugs.