A Few Questions About Lacrimal Glands and Tear Drainage

[Tankie]

Here's a brief update on me:
- Having all 4 plugs really helped. They took away the dry eyes for the most part. A little bit tough first thing in the morning, otherwise I was good to go.
- The problem however is that I had tears overflowing like crazy, and this caused a really bad rash on my face on the skin underneath my eyes due to my wiping away the moisture with my hands or a tissue.
- In the end I decided to remove the upper plugs, and I am wanting to replace them with plugs with a hole (lumen) in the middle.
- These plugs are called flow controller plugs and I have a post about them here: http://www.dryeyezone.com/talk/showt...ghlight=tankie

A new problem I'm facing:
- Despite having my upper plugs removed, I'm still having overflow issues in my right eye when I am active. When walking outside in the cold or when running, I will tear up and overflow. I can't run for more than 30 seconds without overflowing in both eyes, and I can't walk for more than 5 minutes without needing to dab my right eye with a tissue as well. The overflow issues are much worse in my right eye, but they are also present in my left if I'm running.

What I think the problem is (two things I can think of at least):
1. My lacrimal glands produce more tears these days than they used to. Not sure why that would be the case, but this is a possibility.
2. Although the plugs have been removed from the upper puncta, some sort of debris is still up there, and they aren't completely unblocked.

What do I want to do about it (three things I can think of)?
1. Since my eyes still get dry when I'm not walking outdoors or running, I need to keep more tears in the eyes when I'm indoors and working/sitting. To accomplish this, I plan on using a flow controller plug in the upper tear ducts.
2. However, since I'm overflowing already when active, I don't want to make the problem even worse when active, so I need to make sure that the tears will drain away. One way of doing this would be to find a way to reduce the amount of tears that are produced by my lacrimal glands when running or walking outdoors in the cold. Does anyone know if that is even possible?
3. Another possibility is I need to unblock my upper puncta (assuming there's some remaining debris up there since removing the plugs) so that once the flow controller plugs go in they will be able to do their job.


I hope I have done a decent enough job explaining my problem. I'm a little bit in a rush right now so I typed this out very quickly but if anyone has any ideas to help me I'd be very interested in hearing them.

[indrep]

Tankie,
If the overflow is not a problem when indoors and only under the conditions described, I would consider some type of environment control. Eyewear that surrounds the eye area and does not allow wind to blow across the eye. These tears sound more like reflex tears than basal state tears. If there is overflow now, the flow through plugs will contribute to greater overflow.

[gormz]

I second what indrep said. Ive noticed if the wind is blowing or its cold out , i have more tears in my eyes and its most likely reflex tears. The eyewear would fix this since it would maintain a more stable environment around your eyes.

[Tankie]

I understand what you guys are saying, but the same thing happens if I walk around in an indoor shopping mall. I agree that the cold air makes my eyes water more, but the main culprit is when I am active. The tearing is tremendous when I run.

I know it's not the wind by the way... I am 100% sure if I were to run around with goggles on I would tear up in no time. The reason I'm so sure is because I can drive around in my car with my windows down and it doesn't affect me.

[patientpatrick]

Hey tankie what's your schrimer scores? do you naturally produce a lot of tears?

I also know that physical activity greatly reduces inflammation. I know that when I'm very active such as a run, my eyes do not feel dry. Perhaps you're reducing inflammation and your tears are freeflowing without drainage.

Beyond the over tearing though, are your eyes comfortable? Have you tried any other treatments for your MGD? Did you have your upper punctum irrigated?

You problem is very confusing to me. I would think that someone suffering from MGD would experience more dryness outdoors or in areas where the air is cold. I know I do.

I recently had an extensive dry eye workup at a dry eye clinic. I have MGD as well, I also have an aqueous deficiency. I was quadra-plugged back in mid Jan. had collagen plugs in the lowers and extended duration PCL plugs in my uppers. I got marginal improvement. Then after 2weeks when the collagen plugs dissolved I had permanent silicone ones placed in my lowers. I'm still quadra-plugged and still dry. I know the grass is always greener, but I wish I had your problem right now.

I wish you much luck in finding a solution. I have yet to find anything that offers me and substantial comfort.

P

[Tankie]

Hi Patrick. Beyond the tearing, when I had all 4 plugs in place my eyes were very comfortable, something I had not experienced in over 5 years. However, the discomfort from the overflow was significant since I would get a really bad rash on my face from wiping the tears away and it would burn like crazy, so I had to have the upper plugs removed.

As I've said before, I'm still not draining properly. My right eye will overflow with any kind of physical activity, even walking. My left eye will overflow with heavy physical activity such as running.

I did not have my upper punctum irrigated. Please tell me more about this, maybe this is what I need to do!

[DCRdryeye]

Tankie get your upper punctas irrigated. If the saline solution splashes back out of the upper puncta, then you may have a blocked naso-lacrimal duct. If it is a blockage, it could only be a partial blockage.

The physical activity seems to always get things moving more, so it could be a simple as that. However, there's no point getting the flow controller plugs if you're tearing with the uppers removed.

If you've had all four puntums plugged, there are no tears draining into the naso-lacrimal duct which is a long small lumen with mucous membrane and bone around it. It needs to be constantly "moist" from the tears draining through it and into the nose. Now, suddenly it's "dry", the punctums are blocked and the naso-lacrimal duct is deprived of moisture, thus is blocked due to dryness. In fact, an occuloplastic surgeon described this to me during a consultation.

[Tankie]

Tankie get your upper punctas irrigated. If the saline solution splashes back out of the upper puncta, then you may have a blocked naso-lacrimal duct. If it is a blockage, it could only be a partial blockage.

The physical activity seems to always get things moving more, so it could be a simple as that. However, there's no point getting the flow controller plugs if you're tearing with the uppers removed.

If you've had all four puntums plugged, there are no tears draining into the naso-lacrimal duct which is a long small lumen with mucous membrane and bone around it. It needs to be constantly "moist" from the tears draining through it and into the nose. Now, suddenly it's "dry", the punctums are blocked and the naso-lacrimal duct is deprived of moisture, thus is blocked due to dryness. In fact, an occuloplastic surgeon described this to me during a consultation.

Thank you for this! Okay tell me what you think of this:

My thought process on my problem:
1. Before I got my upper puncta plugged my eyes were too dry (i.e. they never overflowed under any circumstances)
2. When they were plugged, my eyes felt great since they trapped all the tears, but it caused a terrible rash due to wiping away the overflow tears.
3. Now that I've had my upper plugs removed, I'm still overflowing in the right eye when walking or running, and I'm overflowing in the left eye when running.
4. I believe that currently my upper puncta or drainage canals are still partially blocked due to some kind of debris that must have built up in the area when I had the plugs in. Therefore I must get this debris removed.
5. If I get this debris removed, I should return to the state I was in in point #1 (eyes too dry, no drainage problems).
6. And now that my eyes are too dry again (at least in theory if I were to get the debris removed), I want to plug them. However, I know that putting in a full plug in the upper puncta gives me overflow problems, therefore I want to put a plug with a hole (lumen) in it. This will hopefully give me enough drainage to prevent overflow, but retain enough liquid to prevent dryness. In other words, I'm trying to find a way to get the perfect balance between drainage and tear production so that despite the fact that my tears don't consist of enough lipids due to my MGD, I will have enough tears present on the surface of my eyes to prevent me from feeling the pain of dry eyes.

What do you think?

Also, how do I "order" an upper puncta irrigation?

I found this interesting article on techniques of re-opening/unblocking the drainage system: http://www.mayoclinic.com/health/blo...ents-and-drugs

Thank you so much by the way!

[patientpatrick]

Hi Tankie.

Your eye doc should be able to irrigate your punctum at your next visit.

The more I read about what you are going through the more confused I get. Based on your posts from way back when, you should be constantly dry after having the uppers removed. Did you get an anethesized schrimer? are you naturally teary?

It's so strange that someone who suffers from MGD gets wetter not drier while outdoors or in cold areas.

In regards to the burning and stinging from your tears. I wonder if your tear osmolarity is high. Perhaps they are extra salty or imbalanced. I would think that tears are a very delicate solution so I don't know why they would burn.

I have eczema and often get red flaky areas around my eyes. I've found that the jergens perfume-free sensitive skin lotion to be very helpful at relieving burning around my eye.

Have you tried any other treatments for your MGD?

p

[DCRdryeye]

Hi Tankie,
It's understandable to think there is some debris left behind after the upper plugs were taken out since you were dry before they were put in. It's just don't know how silicone plugs can break apart in some way, I'd say it could have caused inflammation. I'd get a saline flush done by an eye doctor and go with a course of steroid drops.
With the rash around the eyes, I understand this totally and had it all the time when my left eye was dripping. It aged my skin, but then I heard about placing vaseline around the area to prevent too much dripping.
If the debris or inflammation resolved, yes you'll probably be dry again. But then you can look into the plugs with a lumen in them.
Tankie you don't 'order' an upper plug irrigation. It's done with a needle device that injects saline at high prressure into your upper ducts. Only an ophthalmologist can do it.

It's very difficult and highly frustrating to obtain an ideal balance to obtain adequate tear production, and tear drainage. It's a very complex system.

Keep persisting....let us know how things go