Plugs - Temp. vs. Perm.

[georgiav]

Are Extended Duration punctal plugs (lasting a few months) just as effective as more permanent plugs during the time they last? In other words, are Extended Duration plugs a good enough "test" to see whether plugs work, or do the more permanent type possibly provide better occlusion? Does anyone have any experience with this or have had a doctor address this issue with them?

[indrep]

If the proper size 90 day plugs are used they will occlude 95-100% of the tear flow from the puncta they are inserted. Somewhere around 70 days if your tear flow is good they will begin to dissolve and lose some of their effectiveness.

[spmcc]

My problem with 3-month dissolvables is that the largest size that I could get was .5mm and that's just too small for any of my puncta. At one point, I even had two plugs put up one upper punctum just to see if that would work. I think they just flushed right through the canal with one blink!

Anyway, I don't know if some other manufacturer that I didn't have access to through my doctors makes 3-month dissolvables bigger than .5 mm. So, if your doctor measures you (which he/she *should*) and you're bigger than .5mm, then I wouldn't expect any/much change to your condition. And if they don't work for you, in my opinion, you can't really use the experience to judge whether other plugs will work for you or not.

On the other hand, what the heck?!?! Try them. In my opinion, there's no downside to trying dissolvable plugs (except the cost).

In general, I find plugs to be a very tricky thing... If they work right off the bat, great, you're unique (in my opinion). But I spent 16 years trying all sorts of different plugs - 10-day dissolvables, 3-month dissolvables, 'permanent' silicone, and intracanalicular. I had them in the lower puncta, the upper puncta, then all four puncta. Most of the time, I had no change and one of my doctors who was anti-plug would say, "See! Plugs don't work!".

Now I have all four puncta cauterized or sutured. I'm still dry (no excess tearing), but better than before. So, I would just say, you have to (somehow) find the right doctor, get the right size and brand of plug, cross your fingers, give it some time, and DO NOT judge the efficacy of plugs based on any of your unsuccessful attempts. You just have to keep plugging away (harhar) (unless they cause excess tearing and then I'd say that your problem is probably NOT aqueous).

Good luck!

[Guest]

I've had both the 90 day temps and permanent. For me, the permanent ones did a better job than the temps. But like spmcc says, you've got nothing to lose other than money by trying a pair of temps, so why not give it a go?

[georgiav]

Cauterization/Suturing

Hi Smpcc,

I have both lower puncta cauterized and Extended Duration plugs (lasting a few months) in both upper lids with absolutely no relief from either (nor the full range of other treatments I have tried). I am not sure if I am getting "full" occlusion in the upper lids though. I wonder if there is a way of testing if there truly is full occlusion?

You mentioned that some of your puncta are sutured--is suturing reversible? If so, I would be interested in looking into this. I know if I were to cauterize the upper puncta, there could be excess tearing that would not be reversible. I am curious as to what suturing involves and how many doctors are proficient in doing this. Any information you could provide would be greatly appreciated!

Thank you,
Georgia

[indrep]

Georgia,
a simple way to test for occlusion is to have the doctor look through his slit lamp at your upper puncta and then push on the lacrimal sac and see if fluid comes out of the puncta. If the Extended Duration plugs have been inserted for more than 75 days there is likely to be some extrusion of fluid.

[comizn]

Smartplugs

I had very bad luck with Eagle Plugs that kept falling out. Smart Plugs are comfortable and semi-permanent. They are an alternative to permanent occlusion via cauterization. If you don't develop an infection from Smart Plugs (due to the fact that they are a foreign body) maybe that's the way to go. I have been using them for two months now with no problem but have also been using a good acupuncturist who has been alleviating my severe Dry Eye Syndrome and possibly, it is also helping me to ward off infection. But many people report good results with Smart Plugs.

[skygoddess]

I would be careful with smart plugs, I had endless problems when they migrated .
They do not show up on x-ray, and exploratory surgery is the only option for removal. Eventually I went to only uppers cauterized, but it was a long miserable couple of years.