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**spmcc** · 09-Oct-2012, 17:39

I've had intracanalicular plugs. I got them in my two lower puncta in summer 2009. Everything was fine but I was still very dry. Approx 8 months later, I had them put in my two upper puncta. Within ~24 hours, I had an ooey-gooey infection in both eyes. I was diagnosed with canaliculitis (you could "milk" my puncta). Approx five months later, I ended up having all four plugs flushed with saline and then vigamox (antibiotic drops). I was also given vigamox to use for ~1 week. Within 2 days of having all four plugs flushed, my eyes returned to my "normal" sick dryness. I guess I was lucky.

I am assuming that your doctors have tried flushing the plugs, correct? I guess I don't know how they can tell that they need to be removed surgically. Perhaps you could fill me in.

As for DCR, there is an active member here called DCRdryeye. And if you search DEZ using the term DCR, there may also be others posting about their procedure. Then you can PM them directly.

I hope everything works out for you.

**bbga** · 09-Oct-2012, 18:38

You were VERY lucky. Same here, you can milk my puncta daily and has been that way for a long time. The problem with flushing is that there's a 50/50 chance that the plug could come out, or it could go into the lacrimal sac which then forces me to have a DCR surgery. The surgeon said she wouldn't know if it flushed clear whether it came out or went into the lacrimal sac. I would only know when I started having problems with my lacrimal sac so I don't want to risk that. The canaliculotmy is the standard procedure. They cut the tear duct and scoop out the infection and hopefully the plug with it. The 2nd opinion I got wanted to set me up with general anesthesia with 3 surgeons present. That really scared me so I'm still in search of the right surgeon. Thank you for your kind words and I will definitely search DCRdryeye.

**spmcc** · 09-Oct-2012, 20:10

So your choices are to have the surgery or flush it and have a 50/50 chance of surgery. Is the 50/50 chance your doctor's experience or is this from the literature? And I guess you mean that one surgery is "better" than the other.

I see that this paper talks about irrigation of SmartPlugs: http://www.ncbi.nlm.nih.gov/pubmed/16920195.

A number of sites mention massage. Seems the least likely to cause side effects. Has that been tried?

If you do have them flushed, what are the symptoms/problems if the plug goes into the lacrimal sac? I wasn't told anything - I was just flushed!

I probably don't know enough about DCR - I don't see the reason for a by-pass when the whole reason for a plug is to block the canaliculus. I would actually like to have a canaliculotomy and have all four canaliculi "removed" (I had one sutured but it reopened so I had to have it re-cauterized - I now have all four puncta cauterized). Do you have epiphora?

Perhaps get in touch with these guys: http://www.ncbi.nlm.nih.gov/pubmed/22262291

**DCRdryeye** · 09-Oct-2012, 22:32

I'm almost finished writing an extensive blog about my experience with DCR surgery and what it's done to me. You may wish to read it before making any decisions. I'd suggest they try and flush it out as your first option and if it's pushed into the tear sac, does it really matter if it stays there? The infection is in the calaliculi, not the tear sac.

I'd keep consulting other surgeons, perhaps get a list of them (eg: from the oculoplastic surgeons association) and read their profiles. Chose one who seems to stand out for you.

**Rebecca Petris** · 09-Oct-2012, 22:46

I am sorry to hear what is happening to you. Very hard calls to make going forward. I have been just heartsick over what is happening to a lot of smartplug patients.

There really is good reason to be cautious about irrigating out this kind of plug. I've known several people harmed by smartplugs that went astray in completely unexpected ways.

If I were in this predicament, I think I'd be tempted to get ahold of one of the oculoplastic surgeons involved in the big studies where they did a lot of smartplug repairs, for an expert opinion if nothing else. Maybe someone in the SmartPlug Study Group (let me know if you have trouble getting hold of the names)

**indrep** · 10-Oct-2012, 04:31

IF I were going to ask for irrigation it would be performed in the following manner (assuming the plug is in the lower canaliculus).

I would ask the doctor to irrigate from the UPPER punctum and use their thumb to close the nasal drainage from the lacrimal sac. This would allow the irrigation to force the plug closer to the lower punctal opening. If the lower punctal opening is sufficiently dilated their is a much higher chance of the plug being irrigated out versus trying to irrigate through the lacrimal sac.

**bbga** · 10-Oct-2012, 04:46

I guess it does sound kind of silly that if I flush I would be forced to have surgery and yet I would prefer surgery. The difference between the 2 surgeries are extensive. The surgery to have them removed is a canaliculotomy where they just slit the tear duct and clear out all the infection and hopefully the plug comes out with it. The other surgery is a DCR and it's just horrible, very invasive, lots of risks for other injuries and complications, and is similar to a heart bypass but for your tear duct. If you go on youtube and put in DCR surgery, you'll see what I mean. I've also read medical articles that said that you should never flush a patient with canaliculitis because there is an active infection. The other medical articles I've read says that the infection should be cultured and you should be put on antibiotics after the plug is removed.

I don't have epiphora, just a really nasty infection in both eyes but predominantly in my right eye.

I didn't mean to make it sound like you did the wrong thing and you may have future troubles. It is just me preference to have the canaliculotomy. Here is an excellent article written by a surgeon in Florida regarding the medennium plug and what he does to remove it.

http://www.revophth.com/content/d/fe.../1448/c/27348/

**bbga** · 10-Oct-2012, 04:56

Thank you......so far I've only found one surgeon in Florida that has seen this problem repeatedly in his practice and wrote an article about it. I called his office and his nurse said that since the article he's performed hundreds of these procedures. I live in Ohio and don't really want to go to Florida so I'm praying and believing that I will find someone in Columbus, Ohio that is familiar with this and can do a canaliculotomy. My next appt with a surgeon is Oct 23rd and I'm hoping to have as much information to show him as possible in case he's not familiar with it. One surgeon wanted to flush me and if that didn't work, go for a DCR (in the same surgery). She basically was going to put me to sleep and do a dcr. The second opinion I got wanted to do general anesthesia with 3 surgeons present. Sure seems like a lot of overkill unless he was going to do a dcr once I'm out too. If you could give me some names of some of the people in the study group, I sure would appreciate. Any help or advice would be greatly appreciated. I'm so discouraged and have had this infection for a year now. I just want these things out and to get rid of this infection.
I guess it does sound kind of silly that if I flush I would be forced to have surgery and yet I would prefer surgery. The difference between the 2 surgeries are extensive. The surgery to have them removed is a canaliculotomy where they just slit the tear duct and clear out all the infection and hopefully the plug comes out with it. The other surgery is a DCR and it's just horrible, very invasive, lots of risks for other injuries and complications, and is similar to a heart bypass but for your tear duct. If you go on youtube and put in DCR surgery, you'll see what I mean. I've also read medical articles that said that you should never flush a patient with canaliculitis because there is an active infection. The other medical articles I've read says that the infection should be cultured and you should be put on antibiotics after the plug is removed.

I don't have epiphora, just a really nasty infection in both eyes but predominantly in my right eye.

I didn't mean to make it sound like you did the wrong thing and you may have future troubles. It is just me preference to have the canaliculotomy. Here is an excellent article written by a surgeon in Florida regarding the medennium plug and what he does to remove it.

http://www.revophth.com/content/d/fe.../1448/c/27348/

**bbga** · 10-Oct-2012, 04:59

GREAT IDEA. I will definitely bring this up to the surgeon on my appt this month. THANK YOU.

**spmcc** · 10-Oct-2012, 12:47

Originally posted by bbga View Post

If you could give me some names of some of the people in the study group, I sure would appreciate.

From the study here (http://www.ncbi.nlm.nih.gov/pubmed/16920195), I found

The SmartPlug Study Group consists of the following authors: Joseph A. Mauriello, Jr, MD, private practice, Summit, New Jersey and University of Medicine and Dentistry of New Jersey, Newark, New Jersey; Bita Esmaeli, MD, University of Texas M. D. Anderson Cancer Center, Houston, Texas; Amjad Ahmad, MD, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois; Kathleen F. Archer, MD, private practice, Houston, Texas; Thomas A. Bersani, MD, Eye Plastic and Reconstructive Surgery of Central New York, Syracuse, New York; Kenneth V. Cahill, MD, Ophthalmic Surgeons and Consultants of Ohio, Inc., Columbus, Ohio; Karen L. Chapman, MD, University of South Florida Tampa, Sarasota Memorial Hospital, Sarasota, Florida; Kenneth A. Feldman, MD, private practice, Harbor City, California; James W. Gigantelli, MD, University of Nebraska Medical Center, Omaha, Nebraska; Andrea N. Hass, MD, private practice, Palm Beach Gardens, Florida; Jemshed A. Khan, MD, Khan Eyelid and Facial Plastic, Overland Park, Kansas; Paul D. Langer, MD, private practice, Newark, New Jersey; William J. Lipham, MD, Minnesota Eye Consultants, P.A., Bloomington, Minnesota; Don Liu, MD, University Physicians of Missouri, Columbia, Missouri; Thaddeus S. Nowinski, MD, private practice, Lansdale, Pennsylvania; B. C. K. Patel, MD, Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah; Rona Z. Silkiss, MD, California Pacific Medical Center, San Francisco, California; Valerie Vick, MD, Premier Medical Group, Mobile, Alabama.

If you want the whole paper, just PM me with your email address.

BTW When I had canaliculitis from SmartPlugs, I had my eyes cultured twice (or maybe it was three times!?!). Nothing grew.

**bbga** · 10-Oct-2012, 16:01

Up to this point no one has even offered to culture the infection which is disappointing. As soon as I figure out how to pm you, I'll give you my email address so I could read the whole article. Thank you again for your help.

**spmcc** · 10-Oct-2012, 16:38

I emailed you!

See #1 and #4 on page 3 of this response by Medennium to the 2006 paper by the SmartPlug Study Group: http://www.medennium.com/MedenniumRe...dy%20Group.pdf

Good luck with everything. Please let us know how things go!

**bbga** · 10-Oct-2012, 18:37

I will update again after seeing the surgeon. I hope that documenting my experience will help someone else down the road. thanks for your help.

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Canaliculitis from smart plug - need surgery - need help!!!

Canaliculitis from smart plug - need surgery - need help!!!

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