4 plugs so far no tears

[patientpatrick]

So I went to have a temporary plugs put in today. I had all 4 ducts plugged so I thought I was going to be overflowing. So far I had not been. In fact I placed eye drops in and noticed it went away after 1 min. Is this normal? How long did it take for any of you to experience help after plugs?

[Rebecca Petris]

When you say temporary - do you mean collagen? (Sometimes this term is used for say 3 month dissolvables.)

[patientpatrick]

I had collagen placed on my lowers and PCL extended ones on my uppers since the collagens were too big for my uppers. I know people complain about epiphora and how embarassing overflowing is, but to be honest I was hoping to have some of that. The weirdest part is that I thought since all 4 ducts are plugged, putting in an eye drop would mean they would overflow and fall out. The fact that they stayed in and disappeared in just over a minute makes me wonder whether I was plugged properly or if my eyes were so dry that they absorbed all that moisture, or they just evaporated (although 1 min seems like a fast evaporation rate) I mean I do feel a bit better I suppose, but not what i wanted of course.

Granted I only had the plugs put in about 4 hours ago. But this is still all strange to me. I don't know what's going on.

[Katewest]

Temp plugs didn't do anything for me. But when I had all four plugged with real ones there was a ton of overflow. The problem was no lipids to shield all those tears so my eyes were drier than ever. It only felt good when I was sitting at my desk and looking at the computer. But any air killed.

[Guest]

I had collagen placed on my lowers and PCL extended ones on my uppers since the collagens were too big for my uppers. I know people complain about epiphora and how embarassing overflowing is, but to be honest I was hoping to have some of that.

not sure what PCL extended ones are... are those a form of temporary plugs also? If so, then since you stated that the plugs are helping "a bit", I'd highly recommend going for permanent ones next - there can be a huge difference between the permanent ones and the temporary ones in terms of how many extra tears you notice.

[patientpatrick]

Hey Kate thank you for your reply. So are you still quadraplugged? Did any docs suggest anything for the lipids? Do you have mgd?

Saag PCL is apparently the material the extended temp ones are. I think you had those put in your uppers if I'm not mistaken. It's day 2 for me and my eyes still feel dry but at least they don't seem to be burning as much. I really thought that having 4 plugs would cause epiphora which I was actually looking forward to. I'm so confused.

I had my last schrimer test with 5 in the left and 7 on the right. My tbut is about 5-8 secs. I've read posts from people with much lower scores and suffering from over flooding after being quadraplugged.

I don't know what's wrong with me. I'm not getting even a little over tearing. I was so hoping I would get relief

[jax8it]

Hey Patrick

When I had all four permanent plugs my eyes watered all the time. When I plugged just my left with a lower permanent and a upper 90 temporary I had no overflow.

[patientpatrick]

Hey Patrick

When I had all four permanent plugs my eyes watered all the time. When I plugged just my left with a lower permanent and a upper 90 temporary I had no overflow.

that's very fascinating Jax8it. What were your schrimers and tbut scores? Are you currently using a lower permanent and upper 90 day temp plug? Have you found plugs to be helpful?

I'm debating whether to just give up on them or pursue the permanent ones. I'm still quite confused since the temps seemed rather ineffective.

[jenny2008]

Patrick.. when i tried the temporary dissolvable ones they did absolutely nothing..i dont knwo if my body ate them or what! seriously! i even tried "permanent " smart plugs (which are controversial -at the time didnt know that ) and they didnt work! the only plugs that work for me are the Umbrella type plugs and my upper puncta i had to eventually get cautery as the plugs in the upper puncta irritated my eyes..
keep us posted. i hope you can find the right plugs to get some relief.. you will!!! its trial and error!

[Guest]

Saag PCL is apparently the material the extended temp ones are.

Ok... well sounds like those may be similar to the kind of temp. plugs I had - mine were the kind of temp plugs that are supposed to slowly dissolve over 3 months. Also, I had those 3-mo temp. plugs in all 4 puncta at one point and I had no overflow.

However, with permanent umbrella-style silicone plugs in my lowers, and uppers cauterized (as long as they stay shut haha), I definitely have overflow and it totally rocks compared to being so dry.

So, moral of the story is.... try the permanent ones and odds are good they'll be even BETTER than the temps are at 100% blocking your puncta.... so there's still hope for you to get overflow... no worries!

And as others have said, even overflow is not always a perfect solution since if you don't have enough lipids in your tear film, the tears may still evaporate too fast... but still, a lot of people are way more comfy with overflow compared to not, so I say give the permanent plugs a try! Plus, it's possible that with some of the aqueous deficiency relieved, there may be less inflammation on your ocular surface, which may end up leading to less inflammation in your meibomian glands and improved meibomian gland function... again, you won't know if you'll fit this profile unless you try, right? (Not saying that plugs can't worsen MGD too... but not everyone is the same)

Keep in mind that some docs may hesitate saying something along the lines of "well, if the temps didn't help much, then no point in trying permanant ones". I'd respond to that by saying that you don't know unless you try and there are many reports of people finding the permanents doing a better job of fully blocking the puncta... PLUS, if the permanents don't help, you can always have them removed so it's not like you can't back out later... I can't emphasize enough the fact that you have to at least TRY to see how YOU react to them.

I'm debating whether to just give up on them or pursue the permanent ones. I'm still quite confused since the temps seemed rather ineffective.

No offense, I'm going to be blunt here... please take this in the nicest possible way I see no logical reason NOT to try the permanent ones since ...
a) you noticed "a bit" of improvement with the temps (that could be a sign of good things to come with permanent ones!!!)
b) there have been tons of people on these forums over the years who can vouch for the fact that permanent umbrella plugs worked better for them than temps (if I recall correctly, my own doctor even noticed this in some of his patients... so there is another source of that info)
c) the permanent plugs do not have to be permanent, so if the end up causing more negatives than positives for you, it's easy to get them removed
d) you have no way of knowing for sure whether or not permanent umbrella plugs will help you unless you TRY them... so do it!!!

[patientpatrick]

Thanks SAAG!

The doc that inserted my plugs says i have MGD. I don't have any blepharistis and my lids and ocular surface are all very clean. I just don't seem to produce enough oil from my mebomian glands or tears from my lacrimal glands. I wonder if Lasik caused the lack of oil secretion. I'm going to wait the temp ones out for the next few days and reassess going for the permanent ones. Did you have overflow with permanent lowers and temp uppers?

What i find really hilarious is I went to my Lasik surgeon last week and said I wanted plugs, he suggested permanent ones for the lowers right away. I said another doc suggested using 4 temps in all for ducts as a trial first. He told me doing that would be too much. well guess what its not too much its not even enough.

How are the 4 cauterized ducts treating you? still doing good?

Ok... well sounds like those may be similar to the kind of temp. plugs I had - mine were the kind of temp plugs that are supposed to slowly dissolve over 3 months. Also, I had those 3-mo temp. plugs in all 4 puncta at one point and I had no overflow.

However, with permanent umbrella-style silicone plugs in my lowers, and uppers cauterized (as long as they stay shut haha), I definitely have overflow and it totally rocks compared to being so dry.

So, moral of the story is.... try the permanent ones and odds are good they'll be even BETTER than the temps are at 100% blocking your puncta.... so there's still hope for you to get overflow... no worries!

And as others have said, even overflow is not always a perfect solution since if you don't have enough lipids in your tear film, the tears may still evaporate too fast... but still, a lot of people are way more comfy with overflow compared to not, so I say give the permanent plugs a try! Plus, it's possible that with some of the aqueous deficiency relieved, there may be less inflammation on your ocular surface, which may end up leading to less inflammation in your meibomian glands and improved meibomian gland function... again, you won't know if you'll fit this profile unless you try, right? (Not saying that plugs can't worsen MGD too... but not everyone is the same)

Keep in mind that some docs may hesitate saying something along the lines of "well, if the temps didn't help much, then no point in trying permanant ones". I'd respond to that by saying that you don't know unless you try and there are many reports of people finding the permanents doing a better job of fully blocking the puncta... PLUS, if the permanents don't help, you can always have them removed so it's not like you can't back out later... I can't emphasize enough the fact that you have to at least TRY to see how YOU react to them.

[patientpatrick]

Patrick.. when i tried the temporary dissolvable ones they did absolutely nothing..i dont knwo if my body ate them or what! seriously! i even tried "permanent " smart plugs (which are controversial -at the time didnt know that ) and they didnt work! the only plugs that work for me are the Umbrella type plugs and my upper puncta i had to eventually get cautery as the plugs in the upper puncta irritated my eyes..
keep us posted. i hope you can find the right plugs to get some relief.. you will!!! its trial and error!

Thanks Jenny, so how is the cautery treating you? did you find relief with all 4 puncta cauterized? any overflow? I know its a trial and error thing, hopefully I'll find a combination that works.

[jenny2008]

i have overflow in my left eye but very dry right eye--but i have sjogrens on top of mgd--so i think its the sjogrens doing the dryness to my right...
please keep us posted on what you decide to do..i wish you luck! you will get better!

[patientpatrick]

Hi Jenny. i find it very strange that your sjorgrens would cause such a difference in moisture in both your eyes. Are you plugged any differently in either eye? Is the vision different in either eye? I'm glad you found some reliief at least. I keep hearing about overflowing of tears and how people complain about it, and all I can think about is how much I want that!

[jax8it]

I found the difference in permanent vs. temporary plugs odd too. I only have an umbrella plug in the left lower now. My left eye scores are a 4 tbut and a 4 schirmer. Right eye scores are a 10 tbut and 14 schirmer. My right eye is pretty close to normal, but this eye still hurts. My left eye hurts bad.

Having all four permanent plugs made my eyes feel better at first. My eyes finally had water! It was not perfect, just better. In about two weeks my eyes were worse and the skin around the upper plugs was red and inflamed. I had to have the uppers removed which really sucked because they helped at first. I tried a temporary in my left upper left puncta. I did not notice a difference. However, please don't let me discourage you. Like Jenny said it is all trail and error.