Question about Non Silicone Plugs

[Betsy]

Hi! Thank you for forming this group Rebecca. I am new and this looks like a great source of information. I've learned so much just by reading up so far, as much as my eyes can handle after work.

My mother and I both suffer from dry eyes for years now, due to Sjogren's. But also she's been in menopause and that has affected her hormones, and thus the dryness. Her TBUT score is about 1 second, her Shirmer is better, though not normal.

I've had punctal plugs for years. Her medical insurance is different than my own, and one of the opthamologists wanted her to have her tear ducts cauterized, no other offer made. We very much declined this. The other opthamologist offered her silicone plugs.

For years she said she won't get plugs but she's so bad now, she has no choice. The temporary ones worked well for her. But she fears the silicone in the traditional plugs, like the ones I've worn for years.

So I read about the following plugs on this Dry Eye Talk:

SmartPlug, which is made of a thermodynamic acrylic polymer so that it can conform to the space it's in. Changes shape when warmed up to body temperature and become shorter/fatter to fill the space.

Oasis FormFit plug, which is made of a hydrogel (thought to carry lower risk if it has to be irrigated out) hydrate after insertion and expand to fill the space.

Eagle "Flow Controller" plug and FCI "Perforated" plug, designed for people who experience overflow (epiphora) if full occluded

My question is, are any of the above plugs better so it's worth it for us to keep trying to get her doctor to order them? They don't seem to want to even learn about them. Has anyone had experience with them?

I personally don't get enough relief with my lower plugs. But adding uppers made me always blurry. So I am open to trying something new as well. But my concern now is what to do about my mom whose fearful of silicone migration, however small the chance may be.

Any help appreciated, thank you for allowing me into your group

[indrep]

Betsy
Google search reported problems with Smart Plug and that will reveal the issues with that particular plug. The Oasis Form Fit is a hydrogel material and is 90% water when hydrated in the canaliculus (the drain pipe). There is a new technique for removing the Form Fit, dilate the punctal ring and massage the plug up with a Q-tip.

Several companies have "Flow Control" plugs. The FCI plugs tend to be of a harder silicone, creating more foreign body sensation.

Your mom could always have the 90 day plugs put in every 90-100 days.

[Betsy]

Thank you indrep, I will look up the problems with smart plug to see if it's worth it. The Oasis Form Fit, are there problems with that one? You mentioned I think that it can be a bit difficult to remove? Did I understand correctly? Of course if it works, then I guess we don't need to remove it. If the FLOW CONTROL plugs are not as comfortable, then I guess that option is out. They didn't offer her 90 day plugs. What are those called specifically? They only offered the one week collagen and the regular sillcone permanent ones. If there is something that makes sense, we can try to get them to order them for her, a huge long shot as they are very set in their limited options, but at least I'd know I tried.

[indrep]

Betsy,
Several companies have the Extended Duration (90 day) plugs. They should be able to get those without an issue. They are inserted the same as the collagen ones. I would try those first before moving to any long term plug.

As for the flow controllers, EagleVision and Oasis make the most comfortable ones. Only FCI's are of the more stiff silicone.

[Betsy]

Thank you indrep. I found one company called "prolong" that makes 90 day plugs. But it doesn't say what their made from, she's trying to avoid silicone. The cost to get mine inserted is prohibitive if I wanted to go this route rather than the permanent ones I wear. But she has an HMO and maybe the cost won't be an issue, it's more about whether their willing to do them or not. I will tell her about the flow eagle vision and oasis. Their also made of silicone but less likely to get in your system is that right? How do they compare comfort wise to traditional silicone ones which is what I wear? I see you do warm lid compresses. We've been doing that but need to find something that will stay warmer longer.