Punctal Plugs (Update)

[Tankie]

Here's the update on my situation. It's unfortunately not very good:

1. I had these plugs put in:
http://odysseymed.com/products/paras...re-loaded.html
Size small: 0.40mm-0.55mm
Lumen diameter: 0.20mm

2. Even with the 0.20mm lumen I was still overflowing which caused me a bad rash on the skin under my eyes.

3. My doctor told me my upper puncta are approximately 0.50mm in diameter.

4. When I have no plugs in the upper puncta I get too much drainage.

5. 0.20mm is not enough drainage.

6. Therefore I would imagine I need somewhere around 0.30mm to 0.40mm of drainage diameter to the get the drainage balance I'm searching for.

7. To my knowledge the 0.40mm option is a bit out of the question since they don't make a plug the right size.

8. The doctor told me she could squeeze me into a 0.60mm plug with a 0.30mm lumen by temporarily dialating my puncta, but that's the best I can hope for. The 0.80mm plug with a 0.40mm lumen is out of the question for me.

If only there was another non-permanent way I could alter the size of my puncta. Does anyone have any ideas? I believe in my heart of hearts that 0.40mm is the size I want. I just want to make my puncta a tiny bit smaller. I believe that 0.30mm won't be wide enough, and 0.50mm is too wide as that's how big they are without any plugs.

[Tankie]

I should probably also mention that I've had the upper plugs removed and my under-eye skin is in the healing process.

[indrep]

I am not sure lumen size gets larger with plug size. The reason being the inserters are all the same and a larger lumen would require a larger inserter post for efficient insertion. Typically the plug size is the anchor portion to insure retention. Long term retention is directly related to the smallest plug that fits being used. My concern would be if a larger plug is forced in the retention would be short lived and possible damage to the punctal sphincter could result in not being able to utilize silicone type plugs in the future.

I would consider some type of moisture retention eyewear to help regulate evaporation if that has not yet been tried.

[DCRdryeye]

Hi Tankie,
With the flow control plugs you had, did you notice much rubbing on your eye from them?
As with wanting to reduce the size of your puncta, I'm not sure if that's possible. I'd leave them alone if I were you. As you may know Mawsky and I had a DCR where they surgically ENLARGED our puncta's with a scalpel under anaesthetic without telling us. So our puncta's are HUGE. We certainly wish they could be reduced too. A surgeon placed in a mini-monaka stent in the large puncta's, one came out due to proud flesh growing underneath it (just bad luck). However when she put them in she sewed around the stent which reduced the size of the puncta. The stent that came out, showed the puncta had reduced in size due to the stitching. So I guess there are ways it can be done. You just need to find the correct surgeons for the correct job

[Tankie]

There wasn't any rubbing, no.

I agree, I think I'm going to just leave them alone at this stage. It's interesting because I know it works, but unfortunately achieving the correct balance just doesn't seem possible, out side of what you just suggested.

I'm going to focus on getting my meibum oil running better in that case. Using expression with a Q-tip I'm able to get most of my lower glands to express, which is very good news! The bad news is that the oil coming out is somewhat thick, but not as bad as I've seen in the past for myself. Maybe one day I'll upload a video to youtube showing people how I do my expression. I'll need a really good camera though...

[DCRdryeye]

Yes that would be awesome, or even a mobile phone camera will do