Do plugs deform the puncta?

[Adrian]

I am going to try punctal plugs for the first time. They are the umbrella type, made by the French brand FCI.

Do the plugs stretch/enlarge/deform the puncta permanently, when they are there for some time? How long do they have to be inserted to begin the deformation?

I mean, I want to try how they work. But I don’t want to take them out and realize that I have less tears than before because of bigger puncta…

[PRK]

Hi Adrian, as far as I know the plugs don’t deform the puncta but sometimes the doctor will dilate the puncta before insertion and if they aren’t careful they could “over dilate.” I wouldn’t worry too much about it though. I doubt it would significantly effect the amount of tears your tear ducts would drain.

[Adrian]

PRK, thank you.

Last week a doctor tried to insert a plug, but he wasn't able to do it. He said the plug kept sliding. After five painful attempts, I couldn't stand anymore, so I will go again in some days to try again. The doctor said he usually inserts them quite quickly, in seconds, and this was an exception.

Did this happen to you? Would the plug be too big? (it was a medium size, and this doctor always uses this size)

Is the "over dilation" you mentioned temporary or permanent?

[PRK]

Your doctor is setting off a few alarms with me. First putting in plugs shouldn’t be painful. I’ve never had a plug insertion that was ever uncomfortable. For the most part you shouldn’t really even feel it. The second issue is your doctor always using the same size plug. Plug sizes are greatly different from person to person so he should have tried to figure out your personal customized plug sizes. I have a .5mm silicon plug in my left eye and a .6mm plug in my right eye. Your doctor should have tried a different size plug if the one he was trying wasn’t working.

Is the "over dilation" you mentioned temporary or permanent?

It probably depends on how much they over dilate. But again I wouldn’t worry about it. I’m sure they probably over dilated my tear ducts and I never noticed any difference.

Here is some more info and experiences with punctal plugs…. http://www.dryeyezone.com/talk/forum...gs-have-helped

[Adrian]

PRK, you did a great job gathering the posts about plugs. Thanks for sharing.

What you said about plug size is logical. The problem is that the clinic doesn't have a stock of plugs. They have to ask for them to the prepaid medical company (I don't know if this is the correct way to say it in English). And they ask for a specific size. But I saw my doctor again and now he asked for a smaller size, to see how it works. We'll see.

Thank you very much.

[PRK]

Hope things work out! For me the smaller .5mm and .6mm plugs have been less scratchy and stayed in much longer than the .7mm plugs.

[Adrian]

Hi. It was not possible either with a smaller size. Again, when the doctor tried to insert the plug, it was painful. Once, the first attempt, it seems that the plug was almost inside, but I startled and the opportunity was lost.

The doctor suggested doing the insertion with local anesthetics injected under the eye, and with me lied on a stretcher. But isn't that too much?

Apart from that, I don't know what to do, except trying the absorbable plugs with a different doctor, although I wanted to try a "permanent" one, because I could compare more clearly the difference between Plugs vs No plugs.

[PRK]

If I were you I would look into other doctors. It sounds like your current doctor doesn’t have a lot of experience with this. Also most people I have seen on this forum seem to report absorbable plugs not working very well. I’ve had them too and they didn’t help me at all when compared to the permanent silicon plugs. I should also mention that when my doctor would insert my plugs he would use the slit lamp. He would have me put my head in the chin/headrest and then look at my eye through the microscope so he could see how he was inserting the plug and then he could also check the plug was properly inserted when he was done. This was also more relaxing for me and made it easier for me to keep my head still.

[PRK]

Here is a pretty good video on what punctal plug insertion should be like in my experience.

https://www.youtube.com/watch?v=jdcVl63hxNQ

[PRK]

https://www.youtube.com/watch?v=FkOzu_Xz5RM

[Adrian]

Sorry for the late response.

My doctor also used a slit lamp, in the way you described it.

I had seen some of these videos before. The second one, is like the perfect insertion, huh?

I don't know if it is about experience, I can't judge that. Of course, I could try with another doctor, to see if it is easier.

I will have to be patient and continue my search... I'll tell you if I succeed.

Thanks.