do plugs or cautery help morning dryness?

[zuzu70]

For those of you who got punctal plugs or cautery, did it help alleviate the first-thing-in-the-morning dryness?

One of the worst parts of my day is opening my bad eye first thing when I wake up (or in the middle of the night). One doctor told me that dryness during sleep wouldn't be caused by an overly large puncta, but then again he's the doc who urged me to have the punctal enlargement surgery that got me into this mess, so maybe he doesn't know what he's talking about.

Please please reply with your experiences of plugs/cautery affecting nocturnal and morning dryness. Thank you!

[DCRdryeye]

Hi zuzu, what was your doctors reason for enlargening your puncta? Sounds suspicious to me. Have you tried transquileyes sold at thedryeyeshop? wet the pads, put your favourite eye gel on and put them tranquileyes around your head and you'll wake up with very comfortable eyes

[mgshutterbug]

I don't think the plugs have made any difference with morning dryness. Since we don't blink at night as far as I know (though our eyes may move some) folks with DED have eyes that are basically glued to the eyelid in the a.m. If I don't use thick ointment (Muro 128) at night, my eyes totally dry out, and I will get an erosion as soon as my eyelids move. Sometimes I get an erosion anyway upon awakening, but not most of the time. Muro 128 must be prescribed by your eye doc though, because it's for other specific conditions, not a general "dry eye" product for anyone to use just because they have DED. The tranquileyes with eyegel sounds like a great idea. I can't use them because of the cumbersome headgear I use for bipap every night.

[zuzu70]

Hi zuzu, what was your doctors reason for enlargening your puncta? Sounds suspicious to me.

The optometrist sent me to the oculoplastic for punctal enlargement on the right eye because my right eye was watering intermittently, mostly in the fall & winter. In hindsight I just should have lived with the occasional watering...I had learned how to cope by sticking my pinky into the corner of my eye to dab every once in a while, and in spring/summer the watering went away totally. But optometrist insisted that if I didn't have the surgery, the watering would keep coming back. I was a fool and listened to him. Then the oculoplastic surgeon made things worse, by giving me a "three snip," which involves removing a flap of rectangular tissue surrounding the punctum, instead of the one-snip that I had been told he was doing. And he did both my lowers AND uppers in the same sitting, which I now know was reckless. The cynic in me says it's because doing top and bottom at the same time turns 2 extra minutes in the operating chair into $800 instead of $400 for the surgeon.

The new oculoplastic I'm now seeing thinks that the initial watery eye problem was reflex tearing due to undiagnosed dry eye. Ironic, huh? What has always been a mystery to me is why it was only the one eye that watered. I have never had a problem with my left eye being either too wet or too dry, and still do not.

[zuzu70]

So, would I know it if I were getting corneal erosions? How do you tell? Is it painful? Or is your vision blurry in a certain location, or what?

[indrep]

zuzu
The most common response to your original question of punctal occlusion helping morning issues is no, yes and maybe. If the issue has just started the answer is no. MGD is more likely the culprit. Your closed inflamed lids are in contact with your ocular surface all night causing the the cornea to be inflamed as well. Plugs would not necessarily help here.

If the issue is aqueous deficiency in the early stages and the hyperosmolarity of your tear film is creating inflammation then the inflamed ocular surface and hypertonic tears can cause inflammation of the lids overnight. Plugs would keep the osmolarity in check during the day reducing inflammation.

If the issue has been going on for some time then the issue is multifactorial and would require therapy for aqueous issues and MGD issues.

[hkgcomet]

Plugs don't help you. YOU NEED EYE GEL for sleeping, and plus EYE MASK.

See my post of 10years exp.

My summary on importance things:

1. Genteal Gel for sleeping
2. Wet eye mask for sleeping
3. Sleeping Well with above 2 (Doing top 3 can prevent dark eye next day)
4. Prevent large air-conditioning, big wind, dry places (eg. big AC conference room, car, bus, most dry places I've see) Prevent bright light (eg. movie in cinema, long time using computer, under bright CFL light)
5. Eye drops I use "Reflesh" normal one, it's preversative can break down so can use offen if needed. It's not too thick so would be comfort for normal working days.
6. Blueberry capsule is best nutrition for eye that I've tried

Others:
7. Chinese Medicine, it may be haven't cure my dry eye, but at least can improve my body's health and can keep less tired through the days. (The dry eye start with some body problems 1st)

8. Qi Gong, still under investigation...the last method of all the body's problem...

Other2:
Eye Plugs - I regret to doing this...I got 1 eye fully pluged and 1 eye lhalf pluged.
Now the eye with halfly pluged is only slightly dry, the eye fully pluged afriad of light, irritation easily, sometime with tear run out but eye is still dry

[farmgirl]

Remember that we are all different and what works for one doesn't necessarily work for another. Mostly it is just a matter of taking everyone's suggestions based on their experience and seeing what works for you. Personally for me with all 4 puncta plugged i am a LOT more comfortable during the day and somewhat more comfortable at night. I suffer from aqueous deficiency and I still have to put drops in if I wake up but they are somewhat better. I cannot use Genteal Gel as I am allergic to it and will wake up with red puffy eyes. I sleep with Oniyx goggles and although my lids will be moist the eyes are still dry. What I do believe is important is to find out the nature of your dry eye problem because what works for you will depend on the cause of the problem.

My corneal erosions were mostly symptomatic in that my eyes were very sore and sensitive to light. That has vastly improved with serum drops and punctual plugs. The only way I knew that I had them for sure was if the eye doctors told me that I did otherwise I had no way to tell.

Good luck with finding what works for you and I am sorry to hear that your problem is largely Dr induced...cheers...F/G

[Tankie]

For those of you who got punctal plugs or cautery, did it help alleviate the first-thing-in-the-morning dryness?

I haven't read beyond the first post but for me the answer is no. I still have dry eyes in the morning. What I like to do is wake up, put muro-128 eye drops in each eye, then go back to sleep for 10 minutes. Sometimes I do this more than once, that is, put the muro-128 in, sleep for 10 min, put it in again, sleep for 10 min.

I also just got my shipment today with Hycosan extra strength, so I might mix that into my routine too in some capacity.

I wish they made a preservative free muro-128 eye drop. That way I would be completely off preserved eye drops.

[spmcc]

I wish they made a preservative free muro-128 eye drop. That way I would be completely off preserved eye drops.

Muro 128 ointment is preservative-free. I just noticed that Muro 128 solution contains the preservatives: methylparaben 0.028% and propylparaben 0.012%. Darn - I thought the salt (sodium chloride) in the solution was the preservative!!

As for nighttime dryness... I believe it's a symptom of MGD. Alternately, dryness later in the day is a symptom of AD.

For nighttime dryness, I think it's an absolute MUST to use a good drop/gel/ointment PLUS nighttime cover (e.g., Tranquileyes, Onyix, 3M Micropore tape, or Glad Press N Seal).

[Tankie]

The Hycosan bottles I have are preservative free. The bottles have a button on them to it dispenses 1 drop at a time through a filter. Unfortunately, I believe their bottle design is patented, so it's doubtful we'll be seeing Muro-128 in a bottle like this any time soon.

At least the preservatives are in very low concentration. 0.028% and 0.012%.

[Dog2012]

Hi Tankie, I believe Gentle Gel is still best product i ever tried .

I haven't read beyond the first post but for me the answer is no. I still have dry eyes in the morning. What I like to do is wake up, put muro-128 eye drops in each eye, then go back to sleep for 10 minutes. Sometimes I do this more than once, that is, put the muro-128 in, sleep for 10 min, put it in again, sleep for 10 min.

I also just got my shipment today with Hycosan extra strength, so I might mix that into my routine too in some capacity.

I wish they made a preservative free muro-128 eye drop. That way I would be completely off preserved eye drops.

[farmgirl]

Not sure I agree spmcc. I have Sjorens (aqueous deficient) and have at times woken up with my eyelids stuck to my eyeballs. I am much better now with serum drops and plugs/cautery but still put drops in 2-3x per night as I wake up with gritty eyes. Cannot tolerate gel, not sure why.

[spmcc]

Not sure I agree spmcc. I have Sjorens (aqueous deficient) and have at times woken up with my eyelids stuck to my eyeballs. I am much better now with serum drops and plugs/cautery but still put drops in 2-3x per night as I wake up with gritty eyes. Cannot tolerate gel, not sure why.

"Nighttime/waking dryness=MGD and daytime/afternoon dryness=AD" was a rule-of-thumb my ophthalmologist told me back in 2002. It all centered on blinking (during the day) and not blinking (during sleep).

Scheffer Tseng also wrote about this in his paper A Practical Treatment Algorithm for Managing Ocular Surface and Tear Disorders published in Cornea Oct 2011;30 (Suppl. 1): S8–S14 (pubmed abstract http://www.ncbi.nlm.nih.gov/pubmed/21912234).

He also says daytime/afternoon dryness=AD, but he says nighttime/waking dryness=DTC.

Note that he says punctal occlusion makes DTC worse.

For Table 1 below:
ATD = aqueous tear deficiency due to lacrimal gland dysfunction (‘‘Sjogren-type’’ dry eye)
LTD = lipid tear deficiency due to meibomian gland dysfunction
DTC = delayed tear clearance due to incomplete blinking or eyelid closure
Conjunctivochalasis = excess conjunctiva

** I hope it's okay for me to insert this table as I've referenced it above **

[mgshutterbug]

Update:

I have the most RCEs in the morning upon awakening, tho the last 2 erosions were at work in the middle of the day. Where I worked had pretty warm/hot forced air heat. Worked in nursing home.

I have MGD, ABMD (formerly called EBMD), DED with RCEs due to botched neurosurgery, causing severe nerve damage to trigeminal nerve, including V1. I recently had a 2nd plug inserted in my L eye, the one which is the worst. I have had considerably less pain, and NO RCEs for 2 weeks. I still must put in Genteal Gel drops during day, and Muro 128 ointment at night, but so far, so good. Initially, the overflow was really annoying, tho my eye felt much better. But I couldn't see out of it basically, at all. Now I do have overflow occasionally, but also have mod. severe dry eye occasionally. I don't understand when I've been in the same environment, my apartment w/radiator heat, that both can occur. Anyhow, I use far fewer drops now, and my eye is much more comfortable than before the double plugs. My vision in the L eye is still not good, I can't read out of it 75% of the time because the eye is too wet with tears or drops, or overly dry. Yet, it is still much more comfortable than before the 2nd plug. And my eye was dry almost constantly before, so I couldn't see well out of it anyway. So actually, my vision has improved in that eye with double plugs.

I agree with Farmgirl. We are all have alot in common, but also differences in diagnoses in terms of severity, other related and non-related diagnoses, take different pill medications for various other things wrong with us, and try various treatments specifically for our eye conditions, whatever they may be, whatever the root cause may be. I know I've learned a tremendous amount from the experience, education, and perspectives of others on the forum. It helps me to know what treatments others have tried. It may/may not be something I've tried. But it provides me with more information. What works for one person may/may not work for others. But at least, we're exposed to many options.