Upper punctal plugs

[heyjude0701]

I went to the ophthalmologist today for a follow up since he lasered my lower tear ducts closed, and he was surprised that it didn't solve the problem. He put temporary plugs in the upper ducts and if they help, then he will laser them closed in two weeks. He said he had left the lower ones about 20% open and doesn't want to close them 100%. If that doesn't work, then he said he will prescribe Restasis. I wonder if Restasis will help, though, because he says my eyes are not inflamed at all. Everything I read about dry eye says that inflammation is the cause, so why are my eyes so dry, gritty and sensitive to light if I don't have inflammation?
Judy

[No tears in ATL]

Hey Judy,

I think there was a topic posted here some time ago about inflammation (something about all drops hurting?), and NDrep had a nice summary about tear osmolarity (saltiness) and how that can contribute to inflammation. I think it describes my situation. I don't have MGD or bleph, doc says my tear quality is good (as far as mucus, lipid content) but my aqueous (water) level is way low. I am cauterized on one top duct, plugged on one top duct, and when they are sure my 6 month hydrogel bottom plugs are completely dissolved, the docs will probably cauterize the bottoms.

[heyjude0701]

NT in ATL, did your doctor test your tear quality, can he tell by examining your eyes, or did he dx it by ruling out MGD and blepharitis? I should ask my ophthalmologist about my tear quality. Judy

[No tears in ATL]

I believe (and this has been a long time ago, so I hope I'm getting it right), he did three things. First, put a small slip of paper in both lower lids, which assume was supposed to detect tear volume. Then put a drop of dye in, which may have been the "tear breakup time" measure. Also he did something to measure the evaporative component, in which he said I evaporated within less than 2 seconds. So I think all three of those things your doc should be doing. I had to just flat out ask him. Is it tear quality (oil, lipid) or tear volume? And his response was that it was most definitely a volume issue.

As for the specifics on the actual test and what they are called, I am sure it is somewhere on the forum. Does any of what my doctor did sound familiar to you?

[heyjude0701]

My ophthalmologist didn't do the Schirmer test (the one with the paper); I'm not sure he did the one with the dye. He said I am not making enough tears, which is the impression I have too. I am wondering though if I should get a second opinion from a doctor who specializes in dry eye. I like my ophth a lot, much much better than any of the ophths I had gone to before him. I have been going to him for about five years now. I guess I need to ask him directly if my problem is the quality or quantity of the tears. Judy