Had smartplug removal surgery. It was successful medically BUT, and I'm not sure how

[shoebox]

OK...now for being a chicken...
I've had two bilateral eye infections in the last month and this morning when I got up I'm feeling like another has started.
When I got the first one (EVER), I was visiting Scotland (it was so gross with all that puss and I couldn't really see what we were there to see) and the pharmacist gave me an antibiotic ointment to use. As soon as I got home I saw my primary dr (eye dr was on vacation) and he gave me antibiotic drops, as well as Augmentin for sinus infection. All better for a few days...but a few days after finishing my oral antibiotics, "it came back". So I went to my eye dr, who gave me another kind of antibiotic eye drop with steroid in it, and made a followup for one week later. One week later eyes felt better mostly, but I was having this...pinchy, stuck-together feeling with my eyelid and eyeball way up at the top, especially at night.
OK so upon return, eye dr said he was concerned about continued inflammation. Checked pressure, which was good. So now I have steroid drops for two weeks (I'm starting week two now) and another followup.
Then I read this thread. I have smartplugs (or another brand name, I can't remember) so now I'm scared it's the plugs! My eye dr did "check" the plugs when I saw him the first time after this started - he said they didn't seem to be the cause of irritation, but I thought that meant they were in the right spot and the top ones are flush with my eyelid so they're not scraping or anything. He postulated that antibiotic drops should kill any bacteria around the plugs, too...
AACK!

[LindaT]

I had permanent plugs put in both lower. My eyes began tearing and running down my face. But they still felt dry. I decided to have them removed and they could not find them.
Said I would need surgery to have them removed. They said they had migrated. Not good. I just lived with it and after a few years I thing they are migrated out.

[MelissaK]

Just wanted to update everyone...I had the SmartPlugs surgically removed last Wednesday, May 8th. In the upper right, Dr Gigantelli found 1 plug plus 2 dacryoliths (or "stones" that form as a result of a specific kind of bacteria living in the puncta. This bacteria is a "cousin" to TB and is attracted thermo-acrylic material, which is what SmartPlugs are made out of) and 1.5 plugs in the lower right. He then used a tool he referred to as an "ice-cream scoop" and scraped out the rest of the punctum just to be sure nothing was left behind. My eyes are *definitely* dry again, but I am relieved the disgusting bacteria-laden foreign bodies are gone. I'm still thinking about what my next step will be. Dr. G said he sees about 2 patients a month with "SmartPlug-induced infection occurring 5+ years after insertion where plugs cannot be successfully irrigated and must be surgically removed."

Oops, I misspoke! Dr. says he sees about 4 patients a year--not 2 a month--whose plugs (SmartPlug and other kinds, both Herrick and intracanicular) require surgery to remove. Sorry!

[MelissaK]

Sheila,

Yes, i'll definitely be seeing him for all of my dry eye needs. He already cauterized both lower punctas and will be cauterizing the uppers in July.

Thanks!

[MelissaK]

Anne,
Dr. did not retain the plugs that I am aware of, but he did take pictures of them and showed them to me during my post-op visit.

I live in Nebraska and Dr. Gigantelli is in Omaha.

I am not aware of any lawsuits. Dr. Gigantelli said that although my case is not isolated (as indicated by his previous estimates that he performs this type of surgery about 4 times a year), it is nevertheless quite rare. These 4 surgeries a year he performs for plug removal includes all types of plugs, not just SmartPlugs.

[MelissaK]

Oops, I misspoke. Dr. Gigantelli sees about 4 patients a year whose plugs need surgical removal. Not twice a month!

[anne1232]

Yes, farmgirl, the pieces removed would ne very tiny indeed. But still recognizable as a smartplug, as Melissa said her doctor said, they are of a specific material that could certainly be identifiable

[anne1232]

Melissa, that's great! Glad the surgery went OK. Can I ask if the doctor retained the

the plugs for you? Where are you, where is this great doc willing to candidly discuss this? Are you finding any class action suits happening yet? (against smartplug maker)

[spmcc]

Hi Melissa,

I'm so happy that the infection and plugs are gone! But I'm so sorry that you're back to dry dry dry. Did Dr. Gigantelli give you any ideas of how to 'safely' block your puncta now? I'm glad that he's so good at removing SmartPlugs, but is he someone you'd continue to see for dry eyes?

Happy healing.
Sheila

[MelissaK]

Just wanted to update everyone...I had the SmartPlugs surgically removed last Wednesday, May 8th. In the upper right, Dr Gigantelli found 1 plug plus 2 dacryoliths (or "stones" that form as a result of a specific kind of bacteria living in the puncta. This bacteria is a "cousin" to TB and is attracted thermo-acrylic material, which is what SmartPlugs are made out of) and 1.5 plugs in the lower right. He then used a tool he referred to as an "ice-cream scoop" and scraped out the rest of the punctum just to be sure nothing was left behind. My eyes are *definitely* dry again, but I am relieved the disgusting bacteria-laden foreign bodies are gone. I'm still thinking about what my next step will be. Dr. G said he sees about 2 patients a month with "SmartPlug-induced infection occurring 5+ years after insertion where plugs cannot be successfully irrigated and must be surgically removed."

[MelissaK]

The surgery is the "curretage" mentioned earlier in this thread. He will slice open the punctum until he finds and removes the plugs. A side effect of curretage is that the punctum can scar shut, similar to having it cauterized, which in my case would be just fine because having all four puncta plugged was great for my dry eyes until all the infections began. He said my case of SmartPlug-induced infection happening years after they were inserted was textbook--he sees it all the time

[cristinalatina]

Saw Dr G this afternoon and he agrees surgery is the way to go to remove the plugs. Thanks for the support and prayers! I'm so glad I found this site!!

What kind of surgery, Melissa? Does he expect that the surgery will complicate your lacrimal function/dry eye?

[MelissaK]

Saw Dr G this afternoon and he agrees surgery is the way to go to remove the plugs. Thanks for the support and prayers! I'm so glad I found this site!!

[spmcc]

Got an appointment with Dr. Gigantelli in 2 weeks! Thanks so much!!!

Good luck. Please let everyone know what happens and how it all goes. Fingers crossed for you!

[MelissaK]

I had my 4 Medennium Smartplugs flushed in 2009 due to canaliculitis (you could "milk" my puncta). Anyway, I guess I was lucky because I've had no problems since.

There are tons of published reports about problems with Smartplugs (e.g., http://www.revophth.com/content/d/fe.../1448/c/27348/).

I would keep looking for a doctor who knows what he/she is doing. Search DEZ using the term "smartplug". I know there's a post that discussed the SmartPlug Study Group. Perhaps a doctor in that group is close to you:



Good luck. I hope everything works out.

Got an appointment with Dr. Gigantelli in 2 weeks! Thanks so much!!!