Question about plugs, please help

[Lacrima]

I am about to try silicone punctal plugs. My opthalmologist just ordered them for me today.

He told me he is ordering size 5mm, but he did not examine my eyes at all before doing this. I asked whether he needs to test different sizes and he said no, as he has never experienced anyone who isn't size 5mm.

When I researched online, I read that the size of your punctal opening should be determined before a plug is put in.

Should I just go ahead with getting the plugs inserted?

I would really appreciate feedback especially if you have had plugs inserted.
Please let me know if your punctal opening size was determined before you got them.

Thanks so much.

[Mawsky]

I do have an unusual situation with my Punctum, because I had surgery to open them several years ago, and now they are HUGE. but I know that a couple of Docs told me that they did not have temp plugs big enough for me, but this last visit with the Corneal specialist he inserted plugs in my uppers and one lower Punctum (the other he said has re-closed) So I guess what I'm trying to say is yes people have different sized Punctums, or they would not have different sized Plugs in the offices right? The 5's may be standard and may fit most people but I would check into it, hope some others more experienced than I chime in her, maybe post question on the forum for professionals too. Good luck

[robster]

He said he's never experienced someone who isn't 0.5mm? Well I've got plugs and mine are 0.6mm. My punctal opening size was determined beforehand. Get him to check it will take less than a minute for him to find out what size you will need.

[spmcc]

I find this very unfortunate. I believe this is one of the main reasons why people say, "I've tried plugs and they don't work" and give up. It's so important to find the right doctor who knows what he/she is doing (along with the correct plug type and size for you)!

So, yes, your doctor needs to measure your puncta to determine the size of the plug required for *each* punctum (they may differ - mine do!).

I assume you are paying for these. So, you may get .5mm plugs, have them inserted and they pop out or wash right through the canaliculus. It's a waste of money, time, and hope.

I recommend you try to get your doctor to guarantee that he/she will replace them with a different size if they disappear or don't work for you. I've had plugs pop out on my drive home from the appointment. Luckily, the doctor said, "No problem" and replaced them free of charge. Unfortunately, when this happened a week, a month, or a couple of months later, I paid again for replacement plugs. That's one reason why I eventually went with cautery of all my puncta.

[Rebecca Petris]

I asked whether he needs to test different sizes and he said no, as he has never experienced anyone who isn't size 5mm.

There is a reason plug manufacturers produce different sizes! Hence your doctor's statement must mean either
(a) he has fit so few that it's actually true, or
(b) he hasn't noticed that some of his patients would have benefitted from a different size.

I totally agree with spmcc - there's a great deal of time, money and hope spent in the process. Best spent with a professional who has sufficient experience with plugs, IMHO.

[indrep]

There are studies that show the population is split into approximately five sizes of puncta, from .4 -.8. The breakdown is 40% are .6, 30% - .5, 20% - .7 and 5% each for .4 and .8. Actual numbers would show 1-2% above .8 and 1% below .4. The studies also show that approximately 30% of people have a different size puncta from right to left.

I would ask the doctor does he insert the plug as the package insert instructs, leaving the cap of the plug visible at the punctal ring. If he buries the plug below the punctal ring(not recommended) then absolutely a .5 will fit most everybody.

[Lacrima]

Thank you for your responses, they've been really helpful!

[Trac]

My doctor started out with the smallest plugs and they kept falling out, so he went up in size every time he had to replace them.