4 plugs so far no tears

[farmgirl]

OK, for what it's worth I gotta add my two bits. I had temporaries in all 4, that helped. I got the uppers cauterized and umbrella plugs in the lowers, that helped a LOT. The lower right came out twice so since I didn't have time to get a custom fit one put in I had a longer lasting temporary put in. Now that eye bothers me somewhat where the left doesn't and I know that it isn't plugged as well since at times I can taste my restasis in the back of my throat. Moral of this story is, like SAAG says temporary plugs don't work as well as permanent removable plugs.

At times I get a wee bit of overflow on the left which I don't mind but sometimes the eyelid gets a bit sore from the salt off of my fingers when I wipe it away so I need to resort to carrying a tissue to keep my fingers off of the lid. Hope you find more relied with permanents and I highly recommend you try them...cheers...F/G

[jenny2008]

what city do u live in? if u want u can private msg me... just curious cause i loved living out there.... i miss it! wondering what institute u went to ? doheny? message me if its better! )) if u want..

[patientpatrick]

ps. i just noticed you live in Cali.. i lived in Sherman Oaks for over 9 years but when i got sick came home to the midwest.... i wasnt as bad as i am now..but i wish i would have went to all the awesome docs and eye institutes out there...you are lucky where you live....:0

Hey Jenny. Yeah I'm not so sure about the whole awesome docs in Cali. I had Lasik at a very well regarded eye institute out here and the doctor seems very dismissive of the dry eye caused by it. For a whole year he kept saying keep using drops and it will take time. Finally close to the year anniversary he suggested restasis and wrote me a prescription (seemed a bit late in my opinion) Also I have yet to find a great doc out here in SoCal who's been able to help my dry eye condition. But I am on the hunt for one still.

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

Upper right that got re-cauterized for the 3rd time 1st week of December is still holding strong! WHOO HOOOOOOOOOOO! Maybe the 3rd time was a charm? haha We'll see how long this lasts anyhow... will just enjoy it for now!

Jax8it, if the plugs have caused your skin to be inflamed, would cautery be an option for you?

Jax9it, I though the exact same thing as Patrick... have you considered cautery? I know it must sound like an awful thing to get done, but I think most people (myself included) end up finding it not nearly as scary as it sounds...

[jenny2008]

ps. i just noticed you live in Cali.. i lived in Sherman Oaks for over 9 years but when i got sick came home to the midwest.... i wasnt as bad as i am now..but i wish i would have went to all the awesome docs and eye institutes out there...you are lucky where you live....:0

[patientpatrick]

Jax8it, if the plugs have caused your skin to be inflamed, would cautery be an option for you? Seems like there are quite a few who have found relief with cautery over plugs. Did you notice that the overflow made anything worse?

The differences in your eyes puzzle me very much. Did you have higher myopia in your left?

With a 10 tbut and 14 schrimer they sound okay, i know not nearly as good as you were hoping for.

What makes me so mad is my schrimer scores were 19 and 18 prelasik now they are 7 and 5 (this is after over 2 months of restasis i'm not sure what they were before that) I don't understand how people recover so fast after lasik and I'm 14months post-op and still feel like crap.

[jenny2008]

Patrick/.. NOPE! just lucky..lol.. it used to be my left eye was the worst for 5 years and now the past years the right one.. i have met a few other people with sjogrens who have the same prob..just an odd disease! hopefully one day i will even out and for the better... thanks for caring!!!!

[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.

[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!

[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]

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.

[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.

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!!!

[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!

[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.