Intolerance to plugs

[lizzyk]

Can anyone patient or pro please let me know if they have any info/advice on an intolerance to plugs? Is it even possible to be intolerant or become intolerant to plugs?

Thanks

[mgshutterbug]

Try different plugs?

I first tried a plug 3 years ago in one eye. It was uncomfortable from the time he put it in, and got more so as time went on. By 6 mos, it was causing outright pain, so I had it removed. About a year ago, my new doc put in different kind of plug. She also sized it correctly. I have had no problems with upper or lower plugs in L eye. I did have a granuloma form around the plug in the right eye, which required removal of the plug, but the granuloma closed off the tear duct. Therefore, the duct is closed w/o need for cautery. Most of the time, I do not feel the plugs at all. Once in a great while, I feel the lower plug a little, but it's not painful. Lasts only for some hours that day. That's happened maybe 6 times in a year, which I think is excellent.

[lizzyk]

What type of plugs did you have?

[indrep]

What are the symptoms?
How long have they been inserted with no problems?
How long have the symptoms been present?
What type of plugs are they?

[lizzyk]

I dont know what my very first set were but i think they were silicone they had been in about 4 years and i didnt really notice any problems. About 4 years ago i had plugs inserted in the top as well, as i was constantly applying eye drops, they fell out after a while and my eyes started to feel slightly better. since then i have only had bottom plugs but i have noticed over the last 18 months and several sets of plugs that my eyes seem to feel worse when the plugs are in. They are sore, hot and dry.(without the plugs my eyes are very dry and i have to apply eye drops constantly but somehow they feel better!) the latest plugs are oasis silicone plugs, which i have only had in for 2 weeks but already feeling uncomfortable. I just wondered is it possible to be intolerant or develop an intolerance, if anyone else has experienced problems or is it all in my imagination!

[indrep]

The oasis plugs are silicone which is typically well tolerated unless there is an allergy to silicone. My thoughts are with several plug insertions over 18 months if the tissue is inflamed from irritation. An alternative might be to remove any silicone capped plug and try a 90 day intracanalicular plug. This would remove any irritation of the punctal ring and tissue near the lid margin.

Also Meibomian gland issues could be coming into play. This could be creating a rapidly evaporating tear film.

Is there a time of day when the condition seems worse?

[lizzyk]

Its usually in the eve but can be anytime really.
My eyes feel very hot and look red around the rims. I apply drops constantly as my eyes feels so dry. I had Lipiflow in Feb which doesnt seem to have worked. I was told after the treatment that my glands were clear but i find this hard to believe coz when i press on my eyelids it looks white and thick to me. I had blep last year but that seems to have cleared up with Doxy. There is no sign of blep but the follicles where my eyelash hairs come out of are raised white bumps and sore to touch? I have no idea what this is? I use an eye bag every eve and massage afterwards - im not convinced the heat penetrates far enough to make a difference to the glands but it does soothe my eyes a bit. If my eyes are really sore i'd prefer to put ice on them - but i dont! (The person who carried out my Lipiflow procedure told me it was a waste of time to use a heated eye bag) I popped the plugs out myself last night as i couldnt stand it anymore. I will ask my doc if i can have my punctum cauterized and hopefully i will not suffer any ill effects from this!

[littlemermaid]

Lizzy, I think I would Google 'cytokine eye surface' and search similar in PubMed to read about how inflammatory mediators can pool up in the tear film and eyelid margins in blepharitis.

I think I would consider whether the raised white bumps at the eyelash follicle base might be demodex overgrowth or signs of other infection, and look carefully at cleaning, maybe with a well-tried product. Butterflies Healthcare has got pretty much every blepharitis cleaner to order online. We have treated in case of demodex with organic tea tree shampoo 1:50 diluted in sterile warm kettle water, wiping with cotton wool then into the follicles with cotton buds. We do this everyday for 1 or 2 wks, then maybe once or twice a week. It's done a good job on cleaning, whether it's demodex or not. If it makes the eyes sore, we stop. We also sometimes use Body Shop facewash with TTO, just in case of demodex but also to reduce bacterial load.

Here's Ocusoft and a TTO facecleanser http://www.dryeyeshop.com/eyelid-hyg...ducts-c57.aspx.

We got tear drain infection from punctal plugs and decided not to put them back in because the blepharitis isn't fixed because of skin problems.

Why don't you use a cool pack if you want to?

[dryeye4ever]

anyone knows if a plug can be removed and easily? my plugs dont help at all so im taking appointment with my opthalmologist

[soaps]

Dryeye4eva : yes very easy. drop of anesthetic and simple pluc with tweezers of course that is for umbrella plugs. temp plugs dissolve themselves. smart plugs r difficult i believe.

But its hard to say if plugs r helping. Sometimes removing them feels worse. but worthwhile removing them to c if that helps. trial and error .

[Katewest]

I just took my lower plugs out after a year of them in. Dr. Latkany advised me that they may have been making things worse in my case. No difference yet, its only been 3 days. I took them out myself with tweezers.

[lizzyk]

Kate West - did your doc say why the plugs might be making things worse?

Dryeye4eva - i squeezed mine out with tweezers and it was quite a job but it can be done!

Little Mermaid - i did ask my doc at the eye hosp if i might have Demodex but he said no, i think i might try the tea tree anyway, if its too harsh then i might give the occusoft a try, thanks. I have used Blepasol and Ilast but wasnt keen on either - i think my eyes may just be very sensitive to certain ingredients. I thought a cold pack might further harden the glands so i dont use one - i have no medical knowledge to base this on! Since removing the plugs my eye are still sore so im just about at the end of my tether!
INDREP has suggested intracanalicular plugs but im not sure i want to try anymore plugs!
I only wish i could get a proper, thorough diagnosis of my problems and then take the appropriate steps to deal with it, unfortunately my local eye hosp are not terribly understanding!

[Katewest]

Because I might have allergies....although I've been tested and am neg

[indrep]

I would advise people to only have their plugs removed by an eye care doctor. The silicone that most plugs are made of is very thin and can be easily torn during removal. This complicates removal substantially and can create an"intracanalicular" plug.

[Rebecca Petris]

I would advise people to only have their plugs removed by an eye care doctor.

Strongly seconded. They are not meant to be inserted or removed by anyone but a trained doctor. I've probably set a bad example here by mentioning a few times that I once tweezed one out - it was on a weekend, I was in pain and couldn't get hold of my doctor - but I wouldn't take that risk again, especially after reading so many studies about plug complications requiring surgical intervention.