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**kitty** · 24-Jul-2006, 06:41

I suggest if they are available, that you consider a medium term disolvable plug for your uppers. This will give you enough time to determine benefit (4-6 months) before they melt away. At that time you can then consider "permanent" plugs. I have had my lowers plugged for close to 5 months now with no significant change. I just had the medium term dissolvables placed in my uppers as well. I can't tell a difference yet as far as burning and tear volume, but it has only been a couple of days. The right one fell out on the way home about 20 minutes after it was placed. I get another one placed in my right eye today. I can tell you that my left eye feels a bit more comfortable and the artificial tears stay in there longer.

**shells** · 24-Jul-2006, 14:50

Hi Dotanne,

I just came from my eye doctor, and she also recommended the dissolvable type. My lowers are the silicone kind and still scratch my eyes when they are really dry. I went through alot to get them put in, so rather than just pull them out now, we are gonna make one more attempt at keeping them comfortable. I figure that on my good days when my eyes have more tears, the lower plugs are comfortable, so if I could just keep more tears on my eyes, maye I would be able to tolerate them?? So we agreed that before I have her take out the lowers, we can try the upper plugs to see if that provides adequate moisture. However, she did not want to do the silicone kind up there at first. I'm going to try the 90-day dissolvable ones and see if they help. I'll go back in 3 weeks to get them, so hopefully I won't be tempted to pluck these lower ones out before then!!

Oh, and just incase you want to mention it to your doctor, I've had 90-day dissolvable ones before and they were called "Oasis Extended Duration" punctum plugs. If your lower plugs were possibly causing more inflammation/irritation, and the same thing happens with the uppers, then I think in general these dissolvable ones can be easily irrigated out if they are making things worse for you. My doctor's opinion was that she would rather try those first than put in the silicone kind and then have to pull it out since she didn't want to stretch and possibly scar my upper punctum if we weren't sure they were even gonna help me. Good luck and I really hope you find the right combination of plugs for you!!!

Kitty - I hope that you get your plugs straightened out too, and eventually get some relief from them!

-Shells

**kitty** · 24-Jul-2006, 17:29

Thanks, Shells

Thanks Shells. I got the right upper placed for the second time today. It is still in so I think it will stay! I too hope they provide some relief as there is nothing left for me to try.

**Dotanne** · 25-Jul-2006, 03:06

Thanks Kitty and Shells for your helpful replies. I only hope those plugs are obtainable in NZ. My other ones were the permanent sort that stick out a little bit. The one in my right eye is fine and I only feel it if I pull my eye sideways a little when removing drop residue or if my eye is dry. I will let you know how I fare. Appointment next Monday. My eyes are quite settled at the moment (evening) with no inflamed feeling

. BUT every day starts anew - like your box of chocs Kitty! I just go for it when my eyes are good and relish the moments.

**kitty** · 25-Jul-2006, 17:27

I wish you the best on Monday, Dotanne. Please let us know what happens!

**Dotanne** · 04-Aug-2006, 01:41

Replacement of plug

Kiaora!
I tried to get to see my Lasik Dr re replacing my lost lower plug but he was going away and too busy to fit me in so wanted me(according to his technician) to go to the Dr I had seen on a couple of other occasions and that did my husband's cataracts. So instead of Monday I went to the other Dr today(Friday) and he found he had only the quick dissolving plugs (about 10 days I think) available. My eye seemed to be getting worse and I was desperate for relief so he put one in the top and one in the bottom until he gets some more plugs. He had thought he had a Herrick plug available and had been using Smart plugs so I don't know what I will get in the end. I expressed concern about the ones that you can't tell are there and he tended to agree. The temp plugs have given me some much needed relief

and he did them very easily and quickly.
Shells and Kitty - I do hope your plugs are settling down. I am so glad I had mine put in way back. They certainly helped my eyes become far less dry. It would be good to get on top of the inflamation problem. We can't get the ester type steroids here. We still can't get Systane or Genteal Gel here either. We are probably way behind UK in availability of medicines. They do better in Australia!
Cheers
Dotanne

**kitty** · 04-Aug-2006, 06:22

Hi Dotanne. I'm so glad to hear that the plugs are bringing you relief! Here in the U.S., the newer Herrick plugs are now blue so they can be easily seen. I can see mine without using a light. I have had my medium term upper plugs (Herrick 3-6 month) for two weeks now. The right one fell out about 15 minutes after it was put in and had to be replaced, but it has stayed put this time. My eyes feel more lubricated and I'm not having to use drops as often, but there has been no change in the night dryness or the discomfort I experience while using the computer or driving, or in breezy environments. Most concerning is the increase in burning I have had over the last week or so. I suspect it is because the inflammatory cytokines can no longer be drained away. I recall that my short term plugs dissolved in 3-4 days, and I did not experience increased burning with those. They probably were not in long enough for the cytokines to build up. I had a flare of burning after my permanent lowers were put in as well, about a week or so after. I see my doc today. I will be interested to hear how you do with longer term upper plugs.

**shells** · 08-Aug-2006, 14:32

Dot - Glad to hear that the plugs are giving you relief! Hopefully they will be able to get a more permanent plug for you, or atleast a longer term dissolvable one! I would also be careful with any kind of permanent intracannicular plug. There are risks involved with alot of those.

Kitty - Are you saying that you have 3-6 month dissolvable plugs that are blue and you can see them? I thought that the plugs you had mentioned before that you could see were the permanent Herrick plugs. I'm getting 90-day dissolvables in my uppers on the 17th. I assumed they would be the Oasis Extended duration like I had in my lowers before, but this is a different doctor, so maybe they will be different. I would really be interested in a dissolvable plug that could be monitored though. If you do have ones like that, what is the name of them if you know? Thanks!

Also, sorry to hear that they don't be the ideal solution for you right now. WHat did your doc say when you saw them? My doctor is still not sure if the lowers are causing my inflammation to be worse or not, so we are kind of taking a chance with the uppers. Hopefully my eyes will not have a bad reaction to them. If they do, I guess we'll flush them out. I hope that your eyes have been doing better with the uppers the last few days. Keep us posted on how it goes.

-Shells

**kitty** · 08-Aug-2006, 17:57

Originally posted by shells

Kitty - Are you saying that you have 3-6 month dissolvable plugs that are blue and you can see them? I thought that the plugs you had mentioned before that you could see were the permanent Herrick plugs....I would really be interested in a dissolvable plug that could be monitored though. If you do have ones like that, what is the name of them if you know? Thanks!

Also, sorry to hear that they don't be the ideal solution for you right now. WHat did your doc say when you saw them?

-Shells

Both the medium term and permanent Herrick plugs are Opaque/blue, so they can be easily visualized in the punctum. Medium term Herrick Plugs

My eyes are wetter, I don't need drops as much. I still can't wear contacts and my eyes still burn. My doc considered the quadriplugs a "success" because I was feeling a bit better with them than without. I guess my expectations were higher than his? I go back in November and will decide then to go with another medium term or go for the permanent plugs in the uppers. He does plan to put a larger size in the uppers next time. He said that even the best fitting plugs still "leak" a bit, so 100% occlusion is probably not possible with intracanalicular plugs.

**shells** · 17-Aug-2006, 15:13

Thanks for the info. Kitty. I just got back from my doctor and she put an upper plug in my left eye. She used the Dissolvable Opaque Herrick plug that you mentioned, but she said that she wouldn't be able to see it? So, I'm not sure what is up, according to that website you listed, it should be visible. Anyway, I'll keep everyone posted on how I do. My left eye is the worst eye, so I don't know how much this will help. As long as it doesn't make things worse, I'll probably go back in 3 weeks to get the right eye done. I'm still on the Lotemax for another 2 weeks too, so that might make it a bit hard to truly judge how much the upper plug is helping.

**kitty** · 17-Aug-2006, 15:30

If you take a pen light and hold it on the skin next to the punctum, you should be able to see the plug. You will need to flip the eyelid a bit to get a good look on the uppers. On the lowers, just pull the eyelid down a touch and the punctum and plug should be easily visible. I can see mine without the use of a pen light. Hope that plug works well for you. I am finding that it took me two weeks to start to see some improvement, and 4 weeks to see real improvement. Be patient!

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