Best Punctal Plug

[subashli]

1. Which company manufactures the best, safest and reliable and long lasting punctal plugs?

2. Whic type of plug is best .... Silicone or Hydra gel or something else?

3. How many months or years did your Silicone or other long term punctal plugs last?

4. Difference between punctal and Intracanalicular plugs.

[zuzu70]

I don't currently have punctal plugs, but have done a LOT of reading and can answer some of your questions.

3. The most common cause of plug loss is, well, plug loss. They fall out or (less likely with capped plugs) get pushed down into the canaliculus (drain tube). Almost half of all plugs that are installed, fall out. BUT, for those plugs that do stay in, or those folks for whom the plug does stay in, they could last many years.

4. Punctal plugs stay on top; they plug the opening (punctum) of the drain tube. They have a "cap" on the end so that the plug does not get pushed down into the canaliculus. Intracanalicular plugs are more cylinder-shaped, and they sit all the way in, down in the canaliculus. Many docs are advising against the intracanalicular plugs because they can't be seen so they can't be sure they're working, they can erode through the back wall of the canaliculus, and if they need to be removed they must be irrigated down through the canal, a task which doesn't always succeed.

[spmcc]

When I first started on Dry Eye Talk, I never checked Dry Eye Zone (http://www.dryeyezone.com/). Now I try to remember to check the homepage because there's oodles of great info there.

So, try

1) Dry Eye Zone homepage (http://www.dryeyezone.com/)
2) On the top of the page, click on Encyclopedia (http://www.dryeyezone.com/encyclopedia/index.html)
3) Click on "P"
4) Find entry called "plugs" and there are two links there perhaps helpful for you. Also see entries further down called "punctal cautery", "punctal occlusion" and "punctal plugs" for perhaps additional information.

Good luck.

[Blinks]

Also Rebecca has posted several articles on Smartplugs and adverse events associated with them. May want to do a search on that term for more discussions in the forum. Kudos to you for your "due diligence". Good luck with your quest!

[Rebecca Petris]

1. Which company manufactures the best, safest and reliable and long lasting punctal plugs?

As regards punctal plugs: I don't really believe in a best. The best one for you is the one that fits you best and stays put. This means a doctor who takes plugs seriously and has developed excellent sizing technique as opposed to just tossing the average size in and seeing if it sticks. If the doctor is not well versed in this and not sympathetic to the practical issues (like cost!) associated with plug loss, I would move on.

As regards intracanalicular plugs I'll throw a few thoughts/opinions out there. (Incidentally... omigosh I need to update my plug pages on DEZ so badly. I've been hoping to do a lot of site updates this fall.)

Personally, I do not like the idea of any durable intracanalicular plugs, on principle, and I abhor SmartPlugs in particular as that product's track record is so abysmal it should have been recalled by the FDA some time ago.

Dissolvable intracanaliculars are something I don't really feel I have a good enough sense of yet in terms of safety profiles. There's very little in the literature yet because they're mostly relatively new. However, I just got off the phone with a lady who had to have a papilloma removed (!) from her punctum because of, apparently, canaliculitis from a dissolvable plug. I googled it while speaking with her and right off the bat found a case report from 2009 of someone having the same thing happen because of a collagen plug. Who woulda thunk?

[spmcc]

Here's a review of complications from plugs: http://www.ncbi.nlm.nih.gov/pubmed/22489851

[Rebecca Petris]

...And full text of that abstract

[spmcc]

That paper is out of the UK, so the type/make of plug may be different in other countries. However, the paper does touch on every one of your questions in some fashion.

[indrep]

Having been around punctal plugs for 27 years I could write till everyone went to sleep like Rip Van Winkle.

The best plug is the plug that works best for the individual. Having said that there are some plugs that are more prone to problems. Primarily avoid intracanalicular plugs of the long term variety if at all possible. However there is an option available that does not have the same reported issues as the other types. Also hard silicone plugs tend to create more problems than soft silicone plugs. Plugs with designs of the anchor that can create pressure points also tend to have more reported problems.
Also some problems occur when the insertion technique might not be as good as it can be. This tends to happen with temporary plugs that have less than polished edges.

Having said all of that my wife has been plugged with various plugs for 20 years, the most recent almost 9 years ago with intracanalicular plugs. Punctal plugs have helped a great many people over the years and the vast majority of problems could be avoided if the proper plug was chosen and the proper technique used for insertion.

[subashli]

Thanks all for your valuable suggestions.

[subashli]

I recently came to India and couple of days ago I realized one of my punctal plugs (left eye lower plug) is missing. I went to the doctor today to get a replacement punctal plug for my left eye. To my surprise, the best eye hospital in my city has only one type of plug available i.e. only Lacrimedics OPAQUE Herrick Lacrimal Plugs (non-dissolvable).

The doctor here told me that they have inserted these plugs to some patients and they did not seem to have any problem. But after reading the article, "A review of the complications of lacrimal occlusion with punctal and canalicular plugs", thanks to you guys for sending, I politely declined to have the Herrick plugs inserted. You guys are great .... saved me from these plugs. Many thanks.

The doctor was really helpful though. He said he would source the right plugs for me from USA provided I give him all the specifications/details of my previously inserted plugs (such as manufacturer, type of plug, size, etc).

Now I will have to call up the hospital that inserted plugs in USA and find out the specification of my previous plugs. I do not know if the hospital has a record of my plug details in their database.
Will have to find out.

- Subashli

[bbga]

I have smart plugs that has caused me to have canaliculitis (infection) that won't respond to antibiotics and the plug is the source of the infection. I now have to have them surgically removed. Look up DCR surgery and I think you'll change your mind about having punctal plugs.