Thinking about Punctal Plugs....

[patientpatrick]

Hey everyone. First off Merry Christmas to all of you. It's been over a year post lasik for me and my eyes are still dry and painful. I'm going to a new eye doctor tomorrow afternoon and I'm strongly thinking of getting punctal plugs. I've read Rebecca's introduction to the plugs and there are a lot of options with a lot of pros and cons. I'd love to hear from all of you. Any advice would be much appreciated.

Yours Truly
Patrick

[Guest]

For what it's worth, here's what I've learned:

You can try temporary plugs first - I liked the 3 mo. temp. plugs since it gave me time to figure out what I thought of them.

Temp. plugs often don't plug the puncta as well as permanent plugs, and having all 4 puncta plugged often makes a way more noticeable difference than having only 2 plugged. Point being, if you get plugs in only your lowers and don't notice a huge difference, it doesn't mean that having all 4 plugged won't be fantastic for you.

For permanent plugs, the umbrella plugs are thought by most to be the safest since if they cause you any trouble, they are 1) easy to remove and 2) you can tell FOR SURE whether or not they are still there.

There are also intracanicular plugs, but those can be difficult to remove without surgery for some unlucky people (others can just have them flushed out which isn't too bad apparently... question is, do you feel lucky? haha)

My corneal specialist was totally opposed to the permanent intracanicular plugs due to the difficulties they can cause. (Note, temp intracaniculars are ok since they dissolve away on their own) So he suggested umbrella plugs in my lowers, and cautery for my uppers (since my uppers pointed in such a way that umbrella plugs would have irritated my eyeball if put there... your eyes may be different of course)

I wouldn't be scared of trying plugs... if your doc is good at putting them in, it should go just fine - mine did it textbook perfect - measured the puncta, chose the appropriate size plug, and stuck it in there. They've stayed put nicely for 3 years now.

I'd ask your doc how often he puts them in... how often he/she has trouble with them falling out etc.... will give you an idea at whether or not they've had enough "practice" at it (I only say that because I've seen several stories on DEZ where the dr. chose the wrong size, plugs fell out all the time etc... maybe not all cases are the dr's fault, but still... can't hurt to have a dr. who has had lots of practice before you show up!)

[mgshutterbug]

I'll try to type this more quickly since the longer reply I wrote was just erased when I had to log in again!

I had lower punctal plugs inserted 2 years ago by a corneal specialist whom I belatedly realized was woefully incompetent in every way. Anyhow, after insertion of the plugs, I immediately had considerable discomfort when I blinked. I told him that, he told me that the discomfort was only temporary. I knew nothing about what was going on with my highly damaged left eye (damage caused by botched neurosurgery), trusted him implicitly. I finally insisted he remove them 6 months later because I had outright pain, considerable inflammation. He didn't want to, told me I would be really sorry because I would once again have no tear film. He was right about the tear film, but at least I didn't have additional pain from the plugs.

So my advice to you is, if you have immediate discomfort, let the doc know immediately. A different sized plug, or different shape plug may do the trick.

4 months ago, I had lower plugs inserted successfully, with no pain. They helped alot. More recently had upper plugs inserted also because of RCEs occurring super frequently. I finally had found work again, but in an environment with forced hot air which was always at high temperature. Unfortunately the upper plug will have to be removed tomorrow because the tears are overflowing in that eye, I cannot see well enough to efficiently write notes on the computer.

Because uppers did not work for me, does not mean that if you need them too, that they wouldn't work for you. As SAAG said, it wouldn't hurt to try.

[Guest]

So my advice to you is, if you have immediate discomfort, let the doc know immediately. A different sized plug, or different shape plug may do the trick..

Good advice. It's one thing to "notice" them a little bit when your eyeball looks far to the side of the plug... you might feel a little bit of something there, especially if your eyes are super dry/inflamed that day... but if it's really bothersome and causing PAIN, then nope... I wouldn't think that's normal.

For me, maybe the first few days after insertion I had to make a conscious effort not to look super far in the direction of the plug because if I did, I'd feel it... but this wasn't an omg-painful sensation, and it went away after my eyes got less dry thanks to the help of the plug... now, I only get this if my eyes are super irrirated from dryness, and even then, it doesn't usually happen.

Bad irritation from a plug can't possibly be good though...

[patientpatrick]

Thank you for the reply. I just went to see a Dry Eye specialist yesterday for a dry eye exam. I was told I have an aqueous deficiency I scored a 9mm on a Zone Quick test normal is 20mm+, I was told that the Schirmers test isn't very accurate. This is very depressing. He stated that plugs may not be a good idea because i also have MGD. Seems like plugs may help the aqueous deficiency but would make the MGD worse. Any advice?

Thanks Patrick

[mgshutterbug]

I also have MGD. Having more tears, even without oil, is better than no tears at all, as far as I'm concerned. Artificial tears don't have oil in them either. Does he suggest never using artificial tears as well? My MGD is not worse because of the plugs, not sure why he would say that plugs affect that. But I don't have the in-depth knowledge that others on the forum have. Let's see what other folks say.

[patientpatrick]

Does he suggest never using artificial tears as well?

He actually put me on Oasis Tears Plus. I'm also on Restasis. What have you done in regards to your MGD any successful tips?

[mgshutterbug]

Hi patrick, I'm in chat now. didn't see the "thingie" pop up for chat

[mgshutterbug]

I have't gotten the hang of this chat thing at all

[patientpatrick]

hey no worries i sent you a reply. I think we just missed each other by a few min. I'm sorry. If you're ever around in the future hopefully we can chat.

patrick

[mgshutterbug]

What I was trying to say, Patrick, is that if he recommends using artificial tears, which add an aqueous layer only, why wouldn't he put plugs in which would help you keep the aqueous layer you already make, or which is added by the Oasis Tears Plus? What he says makes no sense to me.

For the MGD, at this point, I don't do anything. I tried rice baggies, warm compresses, with no improvement in comfort or gland flow. Additionally, the rice baggies for me, made my eyes dryer, so I had to stop using them. I even tried putting the rice baggy in a plastic bag, and using a warm, wet washcloth underneath, but that was just cumbersome for me, I never did it right, and would end up with my face and pillow soaked. There's probably a very good way to do this, but I just get super frustrated and stopped trying. I know the warm compresses and rice baggy work for alot of people.

At this point, for general eye care, I have punctal plugs, upper and lower, use Genteal gel drops during the day, Muro 128 5% ointment at night, doxycyline 100 mg which I've only been trying for 2 months. My eye doc is trying doxy to see if it helps the cornea heal more effectively, more strongly. I use Occusoft Plus for lid hygiene.

I have been getting RCEs very frequently at this point, either because I've been extremely dehydrated, which I have because where I was working (nursing home) I had no opportunity to drink fluids between patients. Since I also never had any time for lunch, I'd go easily 8+ hours w/o drinking anything. And I was working in patient rooms where the forced hot air heat was turned up to highest heat because the geriatric patients are always cold. I think both of these had a huge part to play in my RCEs becoming much more frequent, larger, and the cornea failing to heal properly. I'd get another one before the first had time to heal fully. And I had lots of scar tissue which hadn't flattened out fast, increasing odds of new erosions. So I had to begin again with Bandage Contact Lens (BCL) because every blink tore the cornea some, and the pain from the erosions was awful. I was having to use the Muro ointment during the day because I had nonexistent tear film. And then I couldn't see out of that eye to do my documentation. Even with the ointment, my eye was so painful that I was keeping it closed during most of the day while I treated my patients. That wasn't too good, I had all my patients asking me what was wrong with me, and it didn't go over well with my bosses either. Also, inevitably the pain was so bad, vision so bad, I'd have to have emergency eye appointment. So, I am now wearing BCL to give cornea a chance to heal, and to ease the pain. It has been a week since BCL was inserted. I return to my doc early next week for checking on condition of cornea healing, and placement of a new BCL. Hopefully the cornea will heal more quickly than it did the last time it was in this shape. Being able to pay for this care is going to be really challenging since I am now out of work (had to quit job because of my continuing erosions, and poor overall health due to working conditions) and w/o medical coverage. After I get my last paycheck, in 2 weeks, I will be applying for medical assistance. But that can take weeks to get approved.

Anyhow, that's my story. I think keeping hydrated is critical, and I've not been able to do that at all during the past 6 weeks. I've not been able to put in my gel drops much at all during work time. And I also think stress has a big part to play as well in overall eye health. As far as specific treatment for MGD, I don't know how much chance you've had to explore the threads, but there's quite a bit on the forum about different experiences, treatments, that people have tried, along with their relative success with it.

[patientpatrick]

Anyone try the DURAPLUG® Synthetic Extended Temporary Punctal/Canalicular Insert

Here are the details below.

Effective 60 - 180 days. Made of PCL, these are ideal for:

treatment of post lasik induced dry eye.
treatment of seasonal dry eye.
retention of ocular medication.

[Guest]

I replied to your other thread... here's the link to my post if you haven't seen it yet:

http://www.dryeyezone.com/talk/showt...ght=#post79052

[soaps]

Hi Patrick

i have permanent unbrella plugs which can easily be removed despite permanent name. don't get plugs that are fully inserted. my plugs started to cause pain after two months . we removed uppers . redness significantly decreased but eye became dry. Reinserted three days later and now no disccomfort and no increase in redness.
Don't rule plugs out but get umbrella looking ones. sorry not sure proper name.

[littlemermaid]

http://www.dryeyezone.com/talk/showt...9058#post79058 Patrick, Here are replies to your other thread. http://www.youtube.com/watch?v=XOAkmt7RTYk This video Dry Eye Disease by Prof Baudouin is useful if you are talking to your eye doc about plugs and toxic tear.