Canaliculectomy - Smart Plug

[ricklev@hotmail.com]

Three days ago I had a canaliculectomy or a canalucular curretage (not sure which) to remove a smart plug. The doctor said he found many remnants of the plug and removed all that he could find. He said the long term canaliculitus had "melted" the plug into pieces. Does this sound right?

It seemed to go well, although it was an unpleasant procedure. I'm curious to know the recovery period that others have had. I has a bit of sharp pain in my eye now, although it seems to be lessening. Have others who have had the procedure had success to the extent that you were pain free?

I had it done at an expensive hospital in Bangkok, where I live, and the total cost was about 1350 US Dollars. Happily, my insurance paid. How does that compare to the prices in the USA?

I sure wish I had never heard of smart plugs!

[bbga]

I'm looking to have the same procedure to have smart plug removed. could you tell me how they did they procedure on you? Was it a local anesthetic or just done with numbing in the doctor's office? What was the postop? Can't seem to find anyone on this forum other than you that's had this procedure done.

[jenny2008]

i have smart plugs -they never worked for me..no doc ever offered to remove them. i have had cautery on top of them and no issues...Ricklev-what problems did you have with teh smart plugs where your doc found remnants of them?

[DCRdryeye]

Jenny, if you don't have a problem with infections of the canaliculus then there's no need to have the smartplugs removed. I believe ricklev had smartplugs removed due to canaliculitis, and bbga has the same problem and needs smartplugs removed.
I'm curious if the canaliculectomy requires a placement of a mini-monaka stent? Did they put a stent in your puncta to replace the canaliculus ricklev? If they have to cut the canaliculus open, they certainly won't be stitching it back together again. So the mini-monaka stent is the new drainage system. I have a mini-monaka stent in my right eye, it's being used as a punctal plug.

[jenny2008]

im hoping my smart plugs from 3 years ago got flushed through my body cause i have had cautery on top of them in 2 ducts..yikes... anyway. sorry waht you are going thru... as soon as i got the plugs there was no relief at all so the doc assumed miine were flushed out..

good luck with everything ...

[DCRdryeye]

Hi Jenny...eye doctors and others assume too much. I've had Duraplugs put in 3 weeks ago (three put in the left lower puncta, two in the upper puncta...and one in the upper right eye puncta). With all those holes closed, I got no relief at all. I didn't like the attitude of this particular eye doctor who put them in. He was very arrogant and said my eye pain is all in my mind. He was also very fiddly and dropped three of the plugs on the ground whilst he struggled to get them in (no anaesthetic drops). His clumsiness and unethetical attitude made me assume the plugs weren't working because he didn't insert them properly. So I made an appointment with another eye doctor within two weeks whom I'd seen previously with some success. This particular eye doctor was 3 hours away, but a few months ago he put in Duraplugs and I felt some moisture. So he put them in again. Unfortunately, no moisture this time.
So Duraplugs were inserted twice...two weeks apart by two different eye doctors...no relief at all.

The irony of the above scenario is that the Duraplugs were still there. They didn't flush through at all. So in your case Jenny, perhaps a lack of moisture didn't necessarily mean the smartplugs were flushed through. Perhaps you were just very dry and didn't have enough tear production to accumulate? I would assume if smartplugs didn't work, then there was no point getting cautery. So I'm curious, has the cautery worked in terms of providing moisture?

[ricklev@hotmail.com]

I'm looking to have the same procedure to have smart plug removed. could you tell me how they did they procedure on you? Was it a local anesthetic or just done with numbing in the doctor's office? What was the postop? Can't seem to find anyone on this forum other than you that's had this procedure done.

It was done in a hospital operating room with the doctor and two nurses. It took about 40 minutes or so using local anesthetic. In retrospect it wasn't that bad. I had been living with intermittent infections for several years and a chronic infection for about 6 months. I had tried irrigation several times with different doctors and several courses of antibiotics after doing cultures. No luck.

There was irritating pain the first week or so but not too bad and mild discomfort for another two weeks or so. I was constantly worried about the infection returning. However at three months or so I'm now fully recovered I guess with no pain and no infection. Better than I've been in years!

I think I talked about a stent, but because I had no problem with epiphora I think we didn't consider it. Not too sure about this.

The thing with the remnants was weird. At one point the doctor was able to massage out a piece of the plug through a hole in my eyelid created by the infection. After the surgery he showed me a piece of tape that he had attached the little pieces of the plug to as he removed them. I never did understand how it broke up like that. On a couple of occasions a doctor had been poking around at it trying to remove it with forceps (a bad idea, I later learned!) and maybe that had something to do with it.

Hope that helps!

[jenny2008]

yes the cautery has helped so much as did umbrella plugs-which i have on the bottom. for some reason "temporary" or any type of intracellular plugs dont work for me..who knows... the reg plugs and cautery help me sooo much.. but with sjogrens i get flare ups and i get to where i make 0 tears....i have had a flare tho with a missing plug and it is more than a level 10 of pain~!

[bbga]

It was done in a hospital operating room with the doctor and two nurses. It took about 40 minutes or so using local anesthetic. In retrospect it wasn't that bad. I had been living with intermittent infections for several years and a chronic infection for about 6 months. I had tried irrigation several times with different doctors and several courses of antibiotics after doing cultures. No luck.

There was irritating pain the first week or so but not too bad and mild discomfort for another two weeks or so. I was constantly worried about the infection returning. However at three months or so I'm now fully recovered I guess with no pain and no infection. Better than I've been in years!

I think I talked about a stent, but because I had no problem with epiphora I think we didn't consider it. Not too sure about this.

The thing with the remnants was weird. At one point the doctor was able to massage out a piece of the plug through a hole in my eyelid created by the infection. After the surgery he showed me a piece of tape that he had attached the little pieces of the plug to as he removed them. I never did understand how it broke up like that. On a couple of occasions a doctor had been poking around at it trying to remove it with forceps (a bad idea, I later learned!) and maybe that had something to do with it.

Hope that helps!

Yes, this helps a lot, thank you for responding. glad to hear you're all healed now. Hope I can say the same soon.