Need an opinion on plugs

[LisaC]

Hi. I'm not new to dry eye, but I've finally decided to treat mine more aggressively.

I had the strip tear test done recently and my scores were 21 and 30. The 30 was in my left eye, which is strange because this is the eye that feels worse and looks worse.

I have an incomplete blink. My eyes are pretty big and my eyelids do not shut all the way down when I blink or sleep. I have to make a conscious effort to blink VERY hard every few minutes so I know the lid went all the way down. My eyes are also the worst in the mornings when I wake up since they dry out overnight. I have a bad reaction to the ointments I've tried so far, so I am now using Celluvisc before I sleep, which seems to help somewhat.

My glands are not clogged, but I will go for a second opinion on this in March. I don't think they are clogged either.

One doctor said it is clear that my incomplete blink is what causes me so much discomfort because the dry spots on my eye are only on the bottom third of the eye. Also, the redness in my eye is a distinct red stripe of veins across the eye (presumably the part that the lid does not close down over).

I will be asking the doctor about plugs at my next visit, but with a tear test of 30(!!), I'm afraid my eyes will have some severe overflow.

I'd like to be equipped with the proper questions to ask so any response is greatly appreciated.

[Tankie]

The plugs I currently have in all four puncta are:
http://odysseymed.com/products/paras...re-loaded.html
Size small: 0.35mm-0.65mm

I am going to have my upper plugs removed and I am going to replace them with the following:
http://odysseymed.com/products/paras...re-loaded.html
Size small: 0.40mm-0.55mm
Lumen diameter: 0.20mm (as it turns out, currently the lumen size for all odyssey med plugs is 0.20mm)

If I decide I want a plug with a larger lumen size, I may eventually try these out, although I worry about my tear ducts not being big enough for the bigger sizes if I need to switch to the larger lumen plugs:
http://www.dryeye.org/pdf/tearflow.pdf

If you have such high TBUT scores of 21 and 30, you will most likely want a plug with a lumen (hole in the middle). I am personally going to be trying this very soon (in fact the plugs have already been ordered and it`s just a matter of them getting here).

The name of the condition you have for incomplete blinking is called "lagophthalmos". You will need to seek out an oculoplastic surgeon to assess the cause of your problem and then he can surgically repair/alter your eye lids so they close completely. I've had this done myself, and my lagophthalmos is no longer an issue for me.

Good luck!

[Rebecca Petris]

I had the strip tear test done recently and my scores were 21 and 30. The 30 was in my left eye, which is strange because this is the eye that feels worse and looks worse.

Did they anaesthetize your eyes before doing this? If not, then it's mostly just a test of reflex tears. You can have great reflex tearing but still have poor basal tears - and basal tears are more important to your comfort & eye health throughout the day.

Blink issues are a concern for a lot of people with dry eye. If you're affected most first thing in the morning, then you could probably benefit from some kind of physical barrier over the eyes during the night in addition to the lubricant you're using. It can be as simple as a piece of plastic wrap or cheap sleep mask, or as fancy as the moisture goggles made for the purpose.

I would be cautious about pursuing a surgical fix. I've known it to work well for some people (like Tankie!) but I also get regular phone calls from people who inadvertently jumped out of the frying pan into the fire.

[LisaC]

Thanks Tankie. I will definitely ask about a plug with a hole in the middle. I'll look out for your future posts to see how your replacement plugs fare. I'm glad the surgery worked for you, and I'll keep this in mind as a last resort after trying plugs and other methods.

Rebecca - I dont believe he anaesthetized my eyes. I had the test done yesterday and one month ago. Scores were the same each time. However, this was not a dry eye specialist so I will ask about this at my next appointment with a different doctor. I just ordered the rice baggy from your shop to start doing a warm compress and I will pick up a sleep mask soon. I'm still learning a lot here... I'll try the plastic wrap too (do you just wrap this around your whole head to stay put?). In my late teens, I stupidly tried taping my eyes shut with non medical tape only to rip out my eyelashes.

Again, I appreciate the replies. You guys do great work. Both of my parents have dry eye (my mom has a lot of overflow tears with no plugs!) so I'll share some info I learn here with them as well.