Flow Controller Punctal Plugs (Update)

[Tankie]

As of today I have 2 full plugs in my lower puncta, and 2 flow controllers in my upper puncta. More to come in the coming days/weeks.

[patrick]

Hello tankie,

I've read your thread about the punctual plugs with much interest,because i have plans to go the same route.
I recently suggested to my optometrist to put 4 of these plugs in my tearducts just as a trial and see if this could give some relief.
However,she rejected the idea and her argument for not wanting to try this is the fact that i am aqueous deficient to some degree,but as she says not nearly enough to quadra plug my tear ducts.
I do have mgd and the overflow of tears will for sure wash out my already compromised lipid layer even faster than it disappears now by evaporation.
Do you experience something similar? I mean do you feel like you have (more than) enough tears,but it still feels sore because the lipid layer gets washed out much faster than the meibomian glands can produce new lipids to cover the cornea properly.

Thanks for reading,patrick..

[lizzyk]

Flow control plugs

As of today I have 2 full plugs in my lower puncta, and 2 flow controllers in my upper puncta. More to come in the coming days/weeks.

Hi, please let me know how you get on with these flow control plugs

Many thanks

[patientpatrick]

good luck tankie

p

[Tankie]

Hello tankie,

I've read your thread about the punctual plugs with much interest,because i have plans to go the same route.
I recently suggested to my optometrist to put 4 of these plugs in my tearducts just as a trial and see if this could give some relief.
However,she rejected the idea and her argument for not wanting to try this is the fact that i am aqueous deficient to some degree,but as she says not nearly enough to quadra plug my tear ducts.
I do have mgd and the overflow of tears will for sure wash out my already compromised lipid layer even faster than it disappears now by evaporation.
Do you experience something similar? I mean do you feel like you have (more than) enough tears,but it still feels sore because the lipid layer gets washed out much faster than the meibomian glands can produce new lipids to cover the cornea properly.

Thanks for reading,patrick..

It's difficult to say. When I had 4 full plugs in I was overflowing, but the dry eye pain was very minimal due to having my eyes full of tears at all times. They definitely were not the best quality tears in the world, but low quality tears are better than no tears at all in terms of reducing the dry eye pain, that is most certainly a fact.

[patrick]

okay,thanks. i have an appointment with my optometrist again somewhere the next week or so and i'll again try to convince her to fit me with 4 plugs.
maybe she does want to try two full lower lid plugs and two flow controllers for the upper lids. just like you currently have.
to me this sure does sound like a very effective way to keep the eyes as moist as possible without the risk of (too) much overflowing.

good luck with your try out!

patrick..

[farmgirl]

They are your eyes Patrick and what you are asking for is reversible so I see no reason why she should resist??? I am aqueous deficient for sure and not sure about the MGD component but I tried uppers, didn't help. Lowers, didn't help, but when I went to all four, bingo it helped - A LOT so you need to experiment. When I got quadra plugged for the first time they were 3 week dissolvable ones so I didn't need to go back and get them removed.

Controller plugs at this point would probably be jumping the gun. They are special order and I am sure more expensive than regular plugs. Tankie has been experimenting a long time to have arrived at this solution. Start simple and go from there, it is a process. Maybe lowers first then add uppers if that doesn't help. I for sure have no overflow being quadra plugged so flow control plugs would be wasted on me.

It is possible that she is not qualified to insert the plugs so is resistant. If she refuses my advice is to get referred to an opthamologist they are more highly trained than an optometrist....good luck and don't back down...F/G

[patrick]

Hi farmgirl,

Thanks for your reply.
They are my eyes and ultimately it is my decision of course. And i think if i insist on having 4 plugs i can have them inserted.
The optometrist i visit is qualified to insert plugs and she has already placed plugs several times in my lower ducts. Its just that she does believe that the aqueous component of my tears isn't bad enough to justify the inserting 4 plugs at one time.
Having my lower ducts plugged offers relief to some extend,but not nearly enough in my opinion. And as you mentioned quadra plugs Could very well be the magic loop for me and if i don't try i may never know. I guess trying this with dissolvable plugs that disappear after three weeks is quite harmless. After all its a matter of trial and error.

My optometrist also mentioned trying bandage lenses for a while and if this functions good we could consider scleral lenses later on. The reason why she wants to try this is that she thinks that by now my dry eye issues aren't as severe anymore as before (had quite severe mgd that has cleared up considerably). A thing that could have happened in the course of time is a form of neuralgia or so. The nerve endings in my corneas seem to be so enormously oversensitive that i feel like my eyes are dry all the time while in reality they in fact aren't dry at all. It is like a sort of false pain sensation. Well,that is what i understood of her explanation anyway.

My next appoinment is next wednesday. My plan it to propose two full lower plugs and two flow controller for the uppers.
Lets hope i walk out of the door there fitted with these four plugs instead of just two.

Keep you posted..

Patrick.

[DCRdryeye]

Tankie you're correct whilst you had an overflow of tears with 4 plugs, they weren't the best quality tears. This is obviously because ATD/MGD produce pour quality tears. Did you notice the tears weren't normal? Did you notice debris and foreign body sensation in your tears since they had no wear to drain? (they say Restasis improves tear quality).
I've recently been told by a top eye specialist that MGD causes ATD and that ATD causes MGD. So the same with treatment, if you have more moisture around your eyes due to being plugged up, that will help heal the MGD. So one begets the other.
Last week I travelled interstate to a top dry eye surgeon and he said cauterizing my HUGE punctas (due to DCR surgery) would be difficult because each 'zap' causes distortion of the puncta). So he recommended we could try 'flow control plugs' like you've tried Tankie because they manufacture a larger plug than most others. They 'may' fit my gigantic puncta. Not sure yet. I had two Duraplugs put into the huge upper and lower puncta but tears are still draining too quickly through them. So definitely need something more permanent.

[patrick]

Had my appointment with the optometrist yesterday and no,no it's just two plugs for me instead of all 4.
However,there is a difference with the previous plugs i had. Those were always temporary plugs and i now have permanent plugs. Those are believed to stay in for at least two years. They are the umbrella type plugs. I can certainly feel they are there,but they do not irritate in any way. (Till now that is. I have them in for 14 hours now).
I of course asked the optometrist why she is reluctant to placing four plugs and she explained that in my particular case this would certainly result in epiphora and this has one certain and another possible side effect and those are that the already compromised lipid layer gets washed out too quickly and the other side effect could be,and she says that this is not always the case,but still often occurs is that the tear producing gland could get slowed down,because it is receiving signals of overflowing.

On another note. My meibomian glands for some reason seem to do very well! This has been like this for quite a consideral time now. Actually they are doing great since i took a course of doxy (3 months) at the end of 2012.
No clogged gland at all. Clear and easily expressable secretions and a tbut well over ten seconds. This initially was zero till three seconds when i was at my worst!

A little disappointment was that i was expecting to get a bandage lens placed over my cornea's yesterday,but that was not possible because i have a bad cold (like anyone else here in the netherlands. We have the coldest spring in decades. Ughh!)
At the slitlamp the optometrist could clearly see i have some sort of virus in my eyes and placing bandage lenses while there is a virus is just not right. So i have to come back in a couple of weeks when the cold has disappeared and then we can see if these lenses can finally be placed. So,fingers crossed! They seem quite effective as a tool in pain management. We'll see...

Patrick..

[HNautumn]

Patrick how are the new plugs going? do you feel any better than the old one?

[patrick]

Patrick how are the new plugs going? do you feel any better than the old one?

Hello,

I have these new permanent plugs in for about a week now.
I don't have too detailed information about them like brand,size and whatsoever,but what i do know is that they are of the umbrella type and should last for about 2 years or so.
While wearing these plugs i'm told it is necessary to visit the optometrist regularly for check ups. Well,i'm okay with that.

In comparisson to the temporary dissolvable plugs i had previously there are a few differences to note. First of all i can feel they are there,but that is only when i look far to the left or right. When i do that i can feel them scratching my sclera and this feels quite uncomfortable. A positive effect of this scratching is that it causes a small flow of reflex tears and i now use it sometimes to wet my eyes a bit when i feel i could use a little more moist on my eyes.
The other difference i experience is that these permanent plugs retain more moist on my eyes than with the dissolvable plugs. Don't know if this is just my perception or reality. I guess it takes a little more time to find out if the new plugs are really more effective or not. Can't say yet.

Overall i'm quite satisfied with the plugs. They don't bother me at all and i think they are effective. The small discomfort when i look far left or right i can very well live with...

Patrick.

[HNautumn]

Thank you Patrick, im glad that you are satisfied with the new plugs. I went to Mirjam today but no plug for me yet (I had the temporary once, they helps a little though) because my meibomian glands is blocked. She suggest i should take Doxycicline for a month. I just call the GP but he refused to give me. I dont know what to do now really, but have to figure out something.

[patrick]

Hi ashley! Didn't realize it was you. How are you? You did have another forum name previously didn't you?
Anyway. I recognize your problem with the gp concerning the anti biotics. I had exactly the same issue with mine. Grrr!
Doctors here in the netherlands and in europe in general are very reluctant to prescribing anti biotics.
Especially if it is for an eye condition they never ever heard of before.Don't know why,but my guess is that they are afraid of bacterial resistance and the misuse of anti biotics in general.
What you really have to do is ask mirjam to write a referral letter for your gp. In this letter she adresses the matter and explains why a monthly course of low dose doxycycline is highly recommended for meibomian gland disease. I'm sure she is more than glad to make a letter like that for you. And it helps! The moment i could hand over this referral letter i got my prescription for a three months supply of doxy instantly!
The doxy helped my glands tremendously. Till then i always had notoriously clogged glands and a tbut between 0 and 3 seconds. I stopped taking doxy this january and till this point my glands aren't clogged anymore and produce clear and liquid oil.
Don't know how long the effects of doxy will work,but i of course hope it will remain effective for a long long time. Currently my tbut is around 10 seconds. Still not outstanding,but i guess it is for someone who suffers from serious meibomian gland disease.

Let me know how things went.
Good luck...

[HNautumn]

Hi Patrick, Im not Ashley . I did send you a PM sometime back, remember?. Thank you for the advice. I will ask Mirjam for the letter. Best wishes