4 Plugs - gunky around the eyes.

[patientpatrick]

I had marginal success with collagen plugs in the lower punctas and extended duration in the upper punctas. I then had the lowers plugged with silicone plugs and noticed a bit more improvement but nothing huge. My eye doc. then suggested putting silicone plugs in all 4 puncta. This has been a very strange experience.

I've read posts by many of you that plugging all 4 puncta resulted in epiphora, some to the extent that it made it hard to see. As for me, after the procedure I didn't notice much difference at all. In fact for the rest of the day after my eyes still felt dry. But then after about 7 hours or so i noticed that my upper eyelids started itching. I have double eyelids so when I looked in the mirror and noticed salt deposits in between that area and gunk around my eyes.

So far I think i prefer to be quadra-plugged with silicone plugs than not, but I'm not sure how I feel if the itching of my eyelids continue.

The other strange part is I'd say a good 60% of my dryness pain is gone throughout the day. Another 20% of the day I get somewhat excessive gunking (i know that's not a word) out of my eye, and the other 20% of the time my drys still feel very dry.

Anyone experience anything like this?

[DCRdryeye]

Hi Patrick, I know your gunk, dryness, relief, etc is all over the place with being quadrapluged, but as you state: "The other strange part is I'd say a good 60% of my dryness pain is gone throughout the day", then the gunk becomes a non-issue and you'll get used to simply dabbing it off with a tissue or in a water basin if you're near one. And since you've only just had them put in, things change over time. From what I've read, they either go completely dry (fingers crossed for you they don't) or they become more moist. If they become improve things to a positive degree, you maybe a good canditate for cautery.

Itching of the "upper eyelids/punctums" are very common with plugs. Almost everyone experiences this. Again, if they work for you...you won't get itching with cautery. And with all the talk about cautery coming "undone" and needed repeat sessions, find a surgeon who sews over it and had never had a paient re-open again (like my surgeon). I'm just too traumatried from having DCR surgery to have any more procedures done to my eyes.

Good luck, I hope they work well for you. Keep putting in drops, they shoud last longer and make you happier

[patientpatrick]

Hey DCR.

thank you for your reply. getting quadra-plugged was not something i wanted to do but just getting the lowers provided very minimal relief. I guess my big concern is the "toxic tearing" and cesspool of tears that stay in the eye now. While my eyes do feel moister, my eyes feel puffier and my eyelids burn a bit. I flush them out every evening, but i'm concerned that flushing it out would disrupt the tear film.

How did your cautery go?

[Pinky]

Hi Patrick,

I have severe MGD with a lot of inflammation, so I was probably the worst candidate possible for punctal occlusion. But after six years of severe dry eye with no relief, I decided to get cautery. I had previously tried collagen plugs with absolutely no improvements. I first had my lowers cauterized by Dr. ******. He does not believe in plugs because of risk of infection, possible migration into the canal, and also he feels they are not as effective as cautery.

After my lowers were done I had no improvements. A year later, I had all four cauterized at the same time (my lowers had opened), by a doctor in Vancouver. I experienced a lot of mucus. It was horrible, but it cleared in about six weeks. I sometimes get crusting in the corners of my eyes, especially in the morning, but nothing like it was. Most importantly though, I experienced improvements. My eyes are more comfortable and treatments that didn't help before like steroid drops and humidifiers, actually help now.

I was also concerned about "toxic tears" but after the initial side effects from the treatment, I haven't found this to be a problem.

[DCRdryeye]

Hey DCR.

thank you for your reply. getting quadra-plugged was not something i wanted to do but just getting the lowers provided very minimal relief. I guess my big concern is the "toxic tearing" and cesspool of tears that stay in the eye now. While my eyes do feel moister, my eyes feel puffier and my eyelids burn a bit. I flush them out every evening, but i'm concerned that flushing it out would disrupt the tear film.

How did your cautery go?

I didn't actually have cautery done. It was just an option eye surgeons kept pushing down my throat (or eyes I should say hehehe). My particular surgeon "sews" the area where she cauterizes so she has never had a patients cautery re-open on her. If it could be reversed, I might consider getting it done, but my main problem is MGD with ATD secondary. So any tear the cautery would conserve for me, will evaporate (that's my theory). In the end, PAIN forces some of us to get it done.

Toxic tears? well it's best to have some moisture there ALL THE TIME rather than pouring doses of manufactured arificial tears onto the neck (I'm sure some of those would be more toxic in the long term). Aren't you glad you finally feel moisture back in your eyes? It can only get better from now own

[LaDiva]

My guess is mucous Patrick, but it is a guess. If the plugs work, the mucous should improve. Mine has. Best of luck!

[patientpatrick]

Thanks for your responses.

DCR: I am glad to have moisture back in my eyes. It still feels circumstantial though. It's odd that one moment I have gunk flowing between my top eyelids, and the next my eyes still feel dry. I have both MGD and ATD, I've been doing warm compresses for 15 min 3 times a day, the weird thing is, before being quadra-plugged, my eyes felt moister after the compresses, now the compresses make me feel drier after being quadra-plugged.

LaDiva: I'm so glad the plugs are helping you. How long did it take the mucous to improve for you? Are you overflowing?

Pinky: What else have you done to help control your MGD? Did you have your inflammation controlled before Dr. ****** cauterized you? Did the cautery cause more inflammation after having it done? My eye doc is against cautery because he feels it could cause a cascading effect of inflammation, and that having tears hang out in your eyes can cause infection and worsening of other things like allergies in my case.

[Tankie]

When I had 4 plugs in I noticed a little bit of white gunk (I'm almost certain it was mucous) collecting around the upper punctal plug. It never bothered me, and I would just remove it once or twice a day with a Q-Tip (or my finger when a Q-Tip wasn't available, although this probably wasn't a good idea).

Also, if you read my post on "a lesson about punctal plugs" I state that it takes about 10 days for the tears to normalize. If you've only been plugged for a few days, wait a few more and see how you are doing.

Fun fact: I was in Washington today. Nice State you have there =)

[Pinky]

"Pinky: What else have you done to help control your MGD?"

I’m afraid the shorter list is – what haven’t you done? I’ve tried everything – LipiFlow, probing, DHEA drops, Azasite… nothing has helped much. So, unfortunately my inflammation was not under control before having the cautery done. But, after recovering from the initial increase in mucous, the cautery did not make my inflammation worse.

I have come to believe more and more in Dr. Tseng’s treatment protocol, kindly brought to my attention by SPMCC. He believes you have to improve tear film quantity (usually through occlusion) before you can deal with quality. This has proven to be true in my case.

Another thing that has helped me, is adopting an anti-inflammatory diet. My diet has always been very healthy so I wasn’t expecting nutritional changes to make that much of a difference, but it has helped.

There is some exciting new research in the field of immunology that has uncovered natural or benign agents (some of which haven’t been discussed on this board before), that can control NF-κB expression to ameliorate Sjögren’s syndrome and other inflammatory disorders.

I will email you the research.

[patientpatrick]

Thank you Tankie and Pinky I'm a bit early in being quadra-plugged, its only been a week. I'd like to give it some more time and report back.

[spmcc]

I have come to believe more and more in Dr. Tseng’s treatment protocol, kindly brought to my attention by SPMCC. He believes you have to improve tear film quantity (usually through occlusion) before you can deal with quality. This has proven to be true in my case.

That's funny... I thought I got the idea from you and happened upon Tseng's paper that reaffirmed ---

"treat lipid-deficient dry eye after sufficient aqueous tears have been conserved"

http://www.ncbi.nlm.nih.gov/pubmed/21912234

[LaDiva]

Hi Patrick,
The mucous problem has improved, and I would say it took a couple of weeks before my plugs "settled in". Tomorrow the eye doctor will tell me if he is going to plug the tops, and I hope he will. I'd like to see if that pushes things over the big improvement line. My driest eye still has some mucous issues but not like before, and the other eye is doing pretty well. When I first had plugs about two years ago, I had big problems with filaments and mucous. I don't have the filaments anymore, so that may be one reason the plugs are working better. Hope yours work well for you!

[patientpatrick]

Hi LaDiva, what are these filaments you speak of? Good luck with your doctor visit today.

[LaDiva]

They are mucous threads that stick to the surface of the eye. You literally must peel them off, and they come off in strings. It feels like you have a rock in your eye, and can be accompanied by photophobia. http://cms.revoptom.com/handbook/oct02_sec3_4.htm

Good news from the eye doctor today. My plugs have helped and the surface of my eye is much better. Rah! Hope you find the same relief Patrick.

[LaDiva]

Not sure why this posted twice. If someone could remove the duplicate or tell me how, that would be great! (Rebecca! )

They are mucous threads that stick to the surface of the eye. You literally must peel them off, and they come off in strings. It feels like you have a rock in your eye, and can be accompanied by photophobia. http://cms.revoptom.com/handbook/oct02_sec3_4.htm

Good news from the eye doctor today. My plugs have helped and the surface of my eye is much better. Rah! Hope you find the same relief Patrick.