Does this mean plugs will help me a lot?

[romeodakins]

Whenever my eyes get dry I sometimes use my thumb and index finger and squeeze both of my tear ducts really hard so they temporarily close up. It helps for like 3 seconds and I feel slight relief when I do that. Does this mean if I get plugs it will help a lot?

[MartyM1985]

Get the plugs. They have helped me a TON.

I mean, if they don't work or you don't like them, the doc can take them out. Just talk to your doc about the choices you have in terms of plug type.

[romeodakins]

Get the plugs. They have helped me a TON.

I mean, if they don't work or you don't like them, the doc can take them out. Just talk to your doc about the choices you have in terms of plug type.

Thanks! Do you know how much they cost? Also did the plugs make everything normal again or just relieves much of the pain but you still feel the pain?

[mgshutterbug]

Has your doc ever suggested plugs? or anything else? There are pros and cons to having them. You can get infection around them. If you get the temporary ones that dissolve, they can wreak havoc if they drop into the duct itself, sometimes requiring surgery to extricate. Sometimes they scrape the inside of the eyelid, as mine did. I have had plugs for about a year in my left eye, about 6 mos in my R eye. A granuloma developed around the R plug, requiring minor surgery to extricate. It also permanently blocked off the tear duct. For me that was fine, because that eye has only a lower plug, and that eye still gets dry some. But if you have too many tears with a plug in, and then the tear duct scars over, you would need surgery to reverse it, if you wanted to. And the surgery is not always successful. I have both upper and lower plugs in my L eye. Some of the time I have way too many tears, and I overflow. As the tear volume increases, my vision blurs. And then after I blot it, then it's too dry again. Hard to reach a happy medium.

Additionally there are different brands of plugs, and they come in different sizes. A really experienced doctor would be the one to know what to insert. I had a doc insert one in my L lower tear duct 2 1/2 yrs ago (without even asking permission - had no idea what he was doing, he didn't say anything). It was a style that didn't work, plus was the wrong size. It was very uncomfortable from the start, and eventually got downright painful. Had it removed after 6 mos. I suggest becoming as educated as possible of what you're getting into before trying different possible fixes.

[browneyesblu]

My doctor recommended the temporary plugs, I certainly don't want to need surgery. Is it better to go for permanent instead and just have them pulled if there is a problem? I also heard there are types that are easier to extricate, they aren't imbedded?

[zuzu70]

mgshutterbug, you write that temporary dissolvable plugs can wreak havoc if they drop into the duct itself, sometimes requiring surgery to extricate. This makes me very nervous; I have an appointment on the 10th for inserting just such a plug (I think it's the Duraplug but not sure). An oculoplastic doc told me the long-term dissolvables (made from synthetic and not just collagen) can be risky but he did not say why. Since then several people on this board have recommended trying a long-term dissolvable as a way to have a longer time to decide if cautery is for me. Now I don't know which way to go. Do you have more information on the risks of long-term dissolvable plugs? Either personal experience or a website? I thought that it would be okay since it's a dissolvable, but maybe not? Help, anyone, hopefully before my appointment on June 10?

[MartyM1985]

mgshutterbug, you write that temporary dissolvable plugs can wreak havoc if they drop into the duct itself, sometimes requiring surgery to extricate. This makes me very nervous; I have an appointment on the 10th for inserting just such a plug (I think it's the Duraplug but not sure). An oculoplastic doc told me the long-term dissolvables (made from synthetic and not just collagen) can be risky but he did not say why. Since then several people on this board have recommended trying a long-term dissolvable as a way to have a longer time to decide if cautery is for me. Now I don't know which way to go. Do you have more information on the risks of long-term dissolvable plugs? Either personal experience or a website? I thought that it would be okay since it's a dissolvable, but maybe not? Help, anyone, hopefully before my appointment on June 10?

Before I get into my dissolveable history, I will tell you I have had perms in my lowers for a year now, and I have had no issues whatsoever. I love em and they seem to help a ton.

So my short-lived experience with dissolvables in my uppers...

First set dissolved as normal, no issues whatsoever. Then I returned to the doc as my symptoms were still present following the dissolve.


The second set... (this might be hard to follow, so bear with me) This time, I had one perm (L) and one dissolveable (R) put in my uppers. We originally tried two perms at the time, but the one in my right eye was scratching my eye, so we took it out after I had tried it out for about 30 min.

However, since I ended up getting such great relief from the perm in the left eye, I went back to the doc two weeks later to remove the dissolveable in the right and try the perm again in the right eye, as the dissolveable was not getting the job done for me in the right eye.

So, my doc (whom I love) used a water-pump thing to irrigate the upper tear duct and flush the plug out. I can't say it was an entirely comfortable experience, but it was indeed painless.

The dissolveable plug was flushed out, and the doc then put in a permanent plug in my right eye, which I still have now.


My personal advice is to not be afraid of any of these plugs, but that is just from my experience. Yours could end up being different. I will tell you that I have gotten the most lasting relief and recovery from the permanent plugs, and I play to get the uppers removed one day if I'm lucky. If I had a friend ask me what to do, I'd say get the permanent plugs without hesitation.

[Guest]

If you get the temporary ones that dissolve, they can wreak havoc if they drop into the duct itself, sometimes requiring surgery to extricate.

Just to clarify, are you sure this is a problem with the temporary dissolving plugs? As far as I know, this is only an issue with the permanent (ie. non-dissolving) intracanicular plugs - it should not be an issue with dissolvables since they will dissolve and disappear on their own (therefore no surgery needed to remove them)

Sometimes they scrape the inside of the eyelid, as mine did.

I know this must sound very unpleasant Romeodakins, but keep in mind that IF they are put in and they are very bothersome, you can simply ask for them to be removed, which should be an easy thing for the dr. to do.

Some of the time I have way too many tears, and I overflow. As the tear volume increases, my vision blurs. And then after I blot it, then it's too dry again. Hard to reach a happy medium.

I get this too sometimes. However, for me, it's totally worth it since this state of affairs is such an enormous improvement over being bone dry 100% of the time. But definitely worth thinking about, in case you'd feel differently.

Additionally there are different brands of plugs, and they come in different sizes. A really experienced doctor would be the one to know what to insert. I had a doc insert one in my L lower tear duct 2 1/2 yrs ago (without even asking permission - had no idea what he was doing, he didn't say anything).

Agreed! They should measure the puncta first - they have a little tool that does this (it's painless, so no worries on your part!) I've done very well with my plugs - my dr. measured, plus I think has had lots of experience in putting them in - they've been great, and have never fallen out or anything like that.

My personal advice is to not be afraid of any of these plugs, but that is just from my experience. Yours could end up being different. I will tell you that I have gotten the most lasting relief and recovery from the permanent plugs, and I play to get the uppers removed one day if I'm lucky. If I had a friend ask me what to do, I'd say get the permanent plugs without hesitation.

I totally agree with Marty!

As long as you stay away from the intracaniclular permanent ones, and stick with temps or umbrella-style permanent ones, odds are you'll do just fine.

[Cali]

Yes, stay away from the intracaniclular ones (Smart Plugs) and get the umbrella-style. Rebecca has a post about plugs that went into a bit of depth - can't seem to locate it. But the main point is make sure they are umbrella-style so they cannot fall into the tear duct and can be easily removed if necessary.

[Rebecca Petris]

SmartPlugs are long overdue to be banned - their dreadful history of complications is so well documented. Most recent case I heard from, they were on their FOURTH corrective surgery.

You'll hear opinions of all kinds about punctal versus intracanalicular... personally as others have said I'm against any durable intracanalicular ones not because the complications are very very common but because when the complications DO happen, they're BAD ones requiring surgery... no one already in the dry eye frying pan should have to go into that fire. I'd want my plugs where I can see them, and where they can be grabbed & pulled out by the dr. if & when that's needed. Google canaliculitis and you'll see why the ability to remove plugs matters.

One thing that drives me nuts me about plugs is the terminology is inconsistent and very confusing for people who are new to plugs. You never know what they mean when they say permanent (which could simply mean silicone punctal plugs - which are easy to remove anytime) or temporary (which could be days or months). Or even when they say punctal... a lot of times people lump every kind of plug under "punctal plugs" including the kind that go all the way in.

Think of plugs in terms of MATERIAL (silicone, intended to last till it falls out; polymer or other dissolvable, meant to last say 3 to 6 months; or collagen meant only for a brief trial; or thermoplastic which means SmartPlug which means run and don't look back) and PLACEMENT (right in the top of the punctum where you can probably see it's cute little top in your mirror, or all the way into the canaliculus in which case you'll never see it again, even if you really want to).

Sometimes plugging is really simple and just plain works. Other times it's a high art form, trying to get just the right amount of reliable occlusion to keep you both comfortable and without epiphora. A simple litmus test to see if your dr is up to the task just in case you happen to be the type that needs 'plug art' would be to find out from a technician how many/what types of plugs they have on hand.

I don't believe in any absolutes with plugs in terms of who can benefit or not. Seen way too many exceptions to every rule right here on the board over the years

[mgshutterbug]

My apologies, goofed re: which plugs pretty much always cause problems

Thanks SAAG and Rebecca for posting corrections to my previous post on punctal plugs, and for putting caveats in that I should have. I am still getting along without very frequent erosions with one eye double plugged, the other single plugged. I am very grateful to not have the horrific pain of frequent erosions and the ensuing problems very often at this point. But the inability to focus most of the time with my double plugged left eye is a big reason I had to quit my job (or be fired). Most of the time my eyes are too full of tears double plugged to focus well. And after I wipe them then they are too dry to see well, and painfully burning. My doctor said that my tear film is extremely poor, which is why they are burning so bad. That of course is related to MGD - can't seem to get rid of blepharitis in L eye.

I went to an outdoor concert last Friday and sat in misery for 2 1/2 hours. I haven't been outside for that length of time for 3 years since the ill-fated neurosurgery was done. I just wasn't thinking. There was a light breeze, and additionally, I had forgotten to bring my eyeglass shield inserts with me. I can't drive with the inserts on because of blockage of peripheral vision, so I take them off my sunglasses or regular glasses when driving. Anyhow, without the inserts - I was in my own private hell. I couldn't get in the car and leave, I had come with friends and left my purse with inserts at their home. I kept my eye closed for most of the time, but the burning was unreal. I had brought drops, but in that environment, they had little effect. I wanted to get out and be social and normal so bad...I ignored what is. I'm wondering if I wear inserts next time whether I'll be able to stay outside for that length of time. Think I'll drive my own car over, so that if inserts don't help enough, I'll just go home.

[buntbean]

I tried plugs when this 1st started (8 years ago). I was terrified of them and determined not to use them but my doctor insisted. The ones he used looked like a little mushroom. It was so simple to put in and not a big deal at all. They told me to expect discomfort for a few days but the corners of my eyes got blood red and felt unbearable. I kept calling them but they told me to use ointment and give it time. The worst of the two popped out all on it's own and it was blessed relief. I returned a month later and they replaced it only to have the same issues. After 4 attempts the doctor finally admitted that they were actually scratching my eyes! Turns out my lid turns in slightly. That's when he decided to try the Smartplug. He had never attempted it before so I was quite nervous but it seemed like it would solve the problem. Well, he put it in but not all the way and it expanded on the way home with a piece of it sticking out the duct and into my eye. My husband turned the car around and we went back only to have him cut it at the level of the duct. I have corneal neuralgia as well as severe dry eye and it started a horrible onset of the pain. The nerve pain was so intense I was hospitalized. They flushed out the plug and the pain decreased dramatically. My doctor has even changed his opinion about plugs and that no, they don't help everyone. For some it's a dramatic improvement. Putting them in is no big deal and many people have huge benefits so it's always worth a shot.

[buntbean]

I've heard that in some people (esp. with bleth or ocular rosacea), plugs can cause the inflammation (cytokeens?) to be retained in the eyes causing even more pain.