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Punctal plugs less\no drops?

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  • Punctal plugs less\no drops?

    Has anyone had lower punctual plugs inserted and found that they no longer need eye drops? Guessing a reduced frequency is the norm. Also I read on one site that after some people try the temporary dissolvable plugs they tend to cope better with dry eye and never need permanent ones. Any truth in this?

  • #2
    Trying to decide whether to try 3 month temporary ones first or permanent ones. Also the clinic I went to ask to see you 4 weeks after plug placement to check there OK. Is this normal?


    • #3
      I've had both the dissolving and the silicon ones. Either is easy and quick to insert in lower ducts, the upper ducts take a little longer. The silicon are not really "permanent", as they can usually be easily removed, so most people go directly for the silicon. Only cauterization of the ducts is considered permanent. Are you having just the lowers done initially? That's usually what they try first, because I've been told the lowers are responsible for 80-90% of tear drainage. Some people have found also plugging uppers helpful, if lowers is not enough.

      There are a few people who have had problems with the plug in that their duct got infected, or the plug slipped farther down the duct. So the clinic asking you to come back for a check sounds like they just want to make sure it's ok, given it's your first time. Mines just told me if I noticed any irritation, swelling, or pain to give them a call, but for me and usually for most there are no issues.

      Like everything else, the plugs help people to different degrees or not at all. I think there are very few who no longer need to use drops (per your question) after getting the plugs. But given it is relatively quick and easy to do, it's good to try before other treatments, especially if you have aqueous tear deficiency. Good luck!


      • #4
        Thanks yes just the lowers that I am looking at getting plugged. Yes I have aqueous deficiency with low schrimers scores. Are you in the UK? Were I went are charging 50 a plug.


        • #5
          I go on holiday in 6 weeks and every time I go away to hot, sunny climates I have a lot of trouble with my eyes. Guess the air conditioning and dry air on the plane starts the trouble. So looking at getting something sorted before then to see if I get relief when I go.


          • #6
            Do you feel either the dissolvable or silicone ones once in place?


            • #7
              Hi Matt. I'm in the U.S.

              The air on airplanes is common problem for dry eye sufferers, including me. It used to be unbearable flying. Try wearing air shields/goggles on the airplane, while also using a thicker drop or gel drop.

              WileyX, 7Eye, and Ziena are some favorite eyewear. You can get some with clear lenses, and also shaded for using outside or in brightly lit areas if certain lighting bothers your eyes. Some people have prescription lenses fitted in the frames.


              Using thicker drops like Systane Ultra and Refresh Celluvisc, or my favorite Genteal Severe Eye Gel, are usually longer lasting in the eye and I found provided a better barrier to the air and wind than regular drops. I found it helped a little more to use something like Genteal while wearing the eyewear.

              One time I felt a lower silicon plug in one eye because the tip stuck out a little more than the one in my other eye, so the tip was rubbing a little against my top eyelid. But after a day or so I guess it settled in or I got used to it, so no longer noticed it. I didn't feel the dissolvable plugs they tried in my upper ducts, but it made my eyes a weird uncomfortable watery so I knew upper plugs were not for me.


              • #8
                Thanks I will look in to the air shields for the plane. Its the 3month dissolvable or silicone plugs I'll be getting.


                • #9
                  Do you have a really low schrimers score too?


                  • #10
                    You may find it helpful to wear the shields/goggles also when walking outside to protect from the wind and sun. Many people also find it helps to wear indoors too.

                    I used to have no tear film and zero Schirmer in both eyes at my worst. The doctors can physically see I have a tear film now, and I am much better and no longer need to use artificial tears, so they see no need to take Schirmer anymore, but I may ask them to next time just to see what it is now.

                    I still have some remaining dryness from lost/atrophied meibomian glands, and possible from not having an optimal tear film. So I wear scleral lenses 12+ hours a day, which helps a lot. Perhaps something to consider in future. I wear the Boston PROSE sclerals, but there are different brands, this just has a good summary of sclerals in general:



                    • #11
                      Thanks can you still do warm compresses with plugs? Going to book an appointment I'll have to have a think about trying the dissolvable ones or straight to the silicone ones. You sound to have improved your dry eye a lot gives me hope


                      • #12
                        Yes, you can still do warm compresses with plugs, at least the silicon ones. Check with the clinic about the dissolvable ones.

                        Yes, I have improved materially, others in this forum have too, but may not be as active in the forum since getting better. So there is definitely hope! I was so bad off, I had to quit my job and was literally home bound for several years. I could not drive, use electronic devices, read, watch TV, go outside, nothing. All kinds of lighting, sunshine, air conditioning, slight breeze, etc. hurt my eyes even more. Basically stayed home several years with my eyes closed most of the time, the hardest years of my life. But now here I am and can do all those things above and more, so it is very possible to manage this condition.

                        Success can come sooner by being your own advocate and being methodical, doing constant research on doctors and existing/upcoming treatments, getting input from doctors and other dry eye patients like in this forum, really understanding your condition and what likely caused it, inquiring about and trying different treatments suitable for your condition, and trying various diet changes.

                        It can help to do a daily log on 1)how your eyes feel that day, 2)what food, drink, supplements, and meds you consumed, and 3)exercise, hours of sleep, etc. so you can see if any changes in these areas impact your eyes. This is how I determined lemon juice in green tea gave my eyes more moisture, and sugars, gluten, and dairy made my eyes feel drier. Diet changes were a powerful factor in my recovery.

                        So hang in there Matt, it can get better. It may just take some time to find the thing(s) that work for you. I hope the plugs help you, but if not, there is much more to try.


                        • #13
                          Hi Matt: I think I spoke to your problem on another thread but plugs worked so well for me that I had the uppers cauterized permanently and still have the lowers plugged. What did not help me much was to just do the uppers or lowers separately, I need all 4. I think it depends on the nature of your dry eye and mine for sure are aqueous deficient as I have Sjogrens. I am not sure if plugs help with oil deficiency as much as aqueous deficiency but you have nothing to lose in trying and you will never know if you don't.

                          Your decision to use permanent or dissolvable ones may come down to price. The dissolvable ones might be the best way to go in the beginning as they are probably cheaper. I know that the permanent ones were $150 per plug so you would want to make sure that they are going to help if you fork over that much coin.....F/G


                          • #14
                            Thanks the price is the same 50 a plug for dissolvable or permanent. I have book in for just over 2 weeks time. I will discuss which plugs I am getting when I go to the appointment.


                            • #15
                              If the price is the same then I would go with the permanent ones as I found that the dissolvable ones leaked fairly quickly and if they work then you have to pay again for the permanent ones. If they don't work then it is a quick process to remove them. Don't let anyone talk you into inter-canal ones though, make sure that they have the little umbrella to keep them from slipping onto the canal which also makes them easy to remove....F/G