how do you feel when you have permanent silicone umbrella plugs?

[BlueAboutRed]

Dear all,

The previous 1 month, I used temporary dissolvable plugs in lower tear ducts and could feel some improvement in my eyes. As the plugs keep dissolving, I have proceeded to put in permanent silicone plug with cap yesterday.

Question here is that I feel my eyes drier than before the plugs ... is it still early days? When I had temporary plugs, within 24 hours, I felt my eyes more comfortable (though not a lot but I could feel some improvement), but with this permanent ones, I feel drier and have menthol sensation. Is it because the eyes are still adjusting to the cap (There was abrasion in my eyes yesterday but today, abrasion is much lesser)? Anybody has issue with this? I also feel a bit of itch near the area of tear ducts, it is normal?

My opth. did not measure my tear ducts, she simply put in the smallest plugs (Odyssey Parasol Small - 0.35 to 0.65mm).

Appreciate your kind response. Thanks!

Hello Tealeaf. I've had silicone plugs with caps in my lower puncta for about 3 months now. I have good and bad days with them. Some days my eyes feel comfortable and well-lubricated and somedays they don't. I'm not sure where you're feeling the menthol sensation, in your eyes, in your nose or both, but I have that as well. It seems to be from the corners of my eyes closest to my nose and also in my nose. I believe I may be feeling this menthol sensation due to dryness I'm experiencing in my nose and nasal passages due to the reduced amount of tears draining into my nose because of the plugs. While I've been told by both my ophthalmologist and my ENT doctor that they don't believe reduced tear drainage affects the sinuses, I believe it does. I've read where several others on here have also had sinus issues with plugs. I will find the name of that thread and edit it into my post here.

The name of the other thread I posted to about the dryness is: "Punctal plugs and nasal passage discomfort"

[tealeaf]

spmcc,

Oh I see, ok thanks for the information

[spmcc]

SPMCC,
If I am already using Restasis, then gum cellulose should be already in it.

Restasis is cyclosprine in castor oil. What I was saying was when I got *compounded* cyclosporine ("Restasis" in quotations meaning *fake restasis*), the compounding pharmacy put the cyclosporine in methyl cellulose (gum cellulose). So, if you contact a compounding pharmacy you may find that they carry gum cellulose which could be prescribed by itself as an eye drop.

[tealeaf]

SPMCC,
If I am already using Restasis, then gum cellulose should be already in it.

Chella,
Yes, I am an asian.

1 day of DES seems like forever, I fully understand. Guess, plugs help only marginally. I still feel the grittiness on and off. I cannot take Refresh Optive, it creates a "tight" feeling on my eyes.

[spmcc]

I wonder is gum cellulose available in Singapore, where I stay.

I believe that gum cellulose (aka methyl cellulose, CMC) is often used as a vehicle or base for active ingredients. For example, I had cyclosporine compounded in methyl cellulose to make "Restasis". So, your best bet is to contact a compounding pharmacy and ask if they have it. And, actually, I usually don't hear of it being used on its own, but it makes sense since its supposed to be hypoallergenic and nontoxic (mine was also preservative free so it had to be kept refrigerated and used up within a certain amount of time).

Good luck.

[chella21279]

Chella,

Yes, I truly understand how desperate you are to get out of this DES misery. Same here. How long have you been experiencing dry eyes?
May I know which part of Asia are you staying in? I wonder is gum cellulose available in Singapore, where I stay.

Yes, I am still using the permanent plugs with cap. They are less irritating now. But the effect is really marginal. At times, I do feel the tears retained but by lunch time, I have to start using eye drops every 2 hourly.

Do you experience good effect from the plugs? How often do you have to apply eye drops?

Its only been about a month and a half for me. I feel like its been forever

Are you asian as well? I actually don't live in asia. I live in Chicago, Illinois. According to the pharmacist I spoke to gum cellulose is actually really well known overseas. I believe he said in Europe though but I'm not sure. I don't see why you wouldn't be able to obtain it in Singapore.

Did you experience the same outcome when using the temporary plugs? I sort of feel the same with the plugs. They're helping but not by much. I still feel the grittiness/itchiness. But at least I'm not blinking every second.

In conjunction with the gum cellulose, I also use Refresh Optive (non preservative). I use the gum cellulose about 2-3 times a day in the right eye. And about 4-6 times a day of the Refresh Optive in both eyes. Not terrible, considering i was using drops every 20 minutes for the first month.

[tealeaf]

Chella,

Yes, I truly understand how desperate you are to get out of this DES misery. Same here. How long have you been experiencing dry eyes?
May I know which part of Asia are you staying in? I wonder is gum cellulose available in Singapore, where I stay.

Yes, I am still using the permanent plugs with cap. They are less irritating now. But the effect is really marginal. At times, I do feel the tears retained but by lunch time, I have to start using eye drops every 2 hourly.

Do you experience good effect from the plugs? How often do you have to apply eye drops?

[chella21279]

Hi Chella,
Does gum cellulose help you?
I cannot use many eye drops and systane ultra is the one that can help (sometimes refresh plus helps). I have tried many OTC eye drops like cellusivc, bion tears, thera tears, tears naturale, blink, all make my eyes grittier.

When started restasis initially, I had slight stinging at night whereas morning was fine for me (I used the drops twice daily). The stinging lasted about half to 1 hour and for about 1 week, if I remembered correctly. I read in the forum that applying eye drop 5 mins prior to instilling restasis will help reduce stinging.

Great, thanks. At this point, I'm desperate enough to try anything to get me out of this misery.

Yes, gum cellulose works for me. It's also non-preservative and doesn't leave a thick residue. if you contact that pharmacy, the pharmacist can give you all the information you need (since the product is made in their lab).

I've tried many OTC drops as well and almost all of them did not help (probably made things worse) so I totally understand where you're coming from.

Are you still using the permanent plugs? How do they feel on your eyes now? I hope better. Your eyes should start feeling better and a bit more comfortable with them by now I would think.

[tealeaf]

Hi Chella,
Does gum cellulose help you?
I cannot use many eye drops and systane ultra is the one that can help (sometimes refresh plus helps). I have tried many OTC eye drops like cellusivc, bion tears, thera tears, tears naturale, blink, all make my eyes grittier.

When started restasis initially, I had slight stinging at night whereas morning was fine for me (I used the drops twice daily). The stinging lasted about half to 1 hour and for about 1 week, if I remembered correctly. I read in the forum that applying eye drop 5 mins prior to instilling restasis will help reduce stinging.

[chella21279]

Hi Chella,
Yes, I am using vidisic gel and eye mask. I have humidifier in the aircon room too.
My eyes got very dry 1 month post lasik, thus have been troubled by dryness for the past 10 to 11 months

What is gum cellulose? Is it eye drops? I am using systane ultra eye drops and restasis. Restasis helps but to what extend, i have no idea.
Do you intend to have permanent silicone eye plugs?

No worries about the questions, I am also learning and seeking treatment

yes, gum cellulose is a lubricant eye drop similar to an OTC drop. however, a prescription is needed. it is made by leiters pharmacy in san jose (special formula). Systane drops irritates the crap out of my eye

Once my doctor removes my permanant Smart plugs, I will have to see how my eyes feel to determine if I'll be using another plug. it is definitely helping.

When you first began using Restatis, you had no buring at all? I've spoken to many people, and all said there were some burning upon initial use.

[tealeaf]

Hi Chella,
Yes, I am using vidisic gel and eye mask. I have humidifier in the aircon room too.
My eyes got very dry 1 month post lasik, thus have been troubled by dryness for the past 10 to 11 months

What is gum cellulose? Is it eye drops? I am using systane ultra eye drops and restasis. Restasis helps but to what extend, i have no idea.
Do you intend to have permanent silicone eye plugs?

No worries about the questions, I am also learning and seeking treatment

[chella21279]

Hi Chella,
my shirmer test shows 0 mm (R) and 2 mm (L) and TBUT of less than 5 sec for L and 5 to 10 sec for R. My cause of dry eyes is due to Lasik
What is your cause of dry eyes?

I am doing warm compress only once (some how if I do more than once, eye lids feel inflamed even with very low heat. But am doing lid scrub twice a day to get rid of blepharitis. Actually, I am also unsure if the warm compress and lid scrub help, but thought to do it anyway. I suppose if I continue to do for at least half a year, should improve.

What's your TBUT? Do you use eye gel or mask at night to sleep?

I'm not sure what caused it. I have another thread asking that question actually. I believe I genetically have dry eye and one day something caused it to flare up. I'm asian and I've spoken to an asian optometrist..and she pretty much emphasized how asians are prone to having DYS

Yes..same for me with the compresses. I don't know if it helps but I do it anyway..in hopes it will help in the near future. I also feel that after the warm compresses my eyes get a bit more irritated. So I try to add a cold compress afterwards (great 5 minute relief lol). I'm also on the lid scrubs for my mgd/bleph as well. Although, I've heard after the lid scrubs, I am supposed to see some of the bleph "crust" on the towel I'm using? But I'm not seeing any so I'm not sure if it's doing much either =\

My TBUT is 2-3 sec for each eye. When my DYS began which was about a month and a half ago..I had a lot of trouble sleeping since I didn't use a gel to sleep. But after I got the plug..it's gotten better where I don't feel the need to use a nighttime gel. My eyes aren't as red and inflamed now and I am able to sleep more than 5 hours a night..hooray! How about you? Are you using a gel/mask for nighttime?

For what it's worth, my ophthalmologist prescribed me an dry eye drop called gum cellulose. I've heard it works wonders. I started it today and it totally took away the irritation in my right eye. Oddly, I can't say it gives me any relief in my left eye so I'm using refresh optive for my left. Are you using any artifical tears?

How long since you've gotten lazik? So is the restasis not completely helping? Hence why you're needing the plugs as well?

My apologies for all the questions. I am relatively new to this whole dry eye issue.

[tealeaf]

Hi Chella,
my shirmer test shows 0 mm (R) and 2 mm (L) and TBUT of less than 5 sec for L and 5 to 10 sec for R. My cause of dry eyes is due to Lasik
What is your cause of dry eyes?

I am doing warm compress only once (some how if I do more than once, eye lids feel inflamed even with very low heat. But am doing lid scrub twice a day to get rid of blepharitis. Actually, I am also unsure if the warm compress and lid scrub help, but thought to do it anyway. I suppose if I continue to do for at least half a year, should improve.

What's your TBUT? Do you use eye gel or mask at night to sleep?

[chella21279]

Chella, yes, I think is wise to remove the smart plugs to prevent unnecessary complication in future. Already with dry eyes, we wouldn't want to add more worry.

I have used restasis for 8 months; no burning and is comfortable to my eyes when I put them in, I keep the vial in the fridge.

I have evaporative dry eye plus insufficient tears too. I hope I will get used to the plugs after a few weeks. You may want to do warm compress and lid scrub to help you in the lipid layer to improve evaporative dry eye.

Thank you so much for the advice! Now I am a bit worried if my doctor will even know if its out, when he does remove it.

Thats great to hear! I will definitely give it a shot. How bad are your dry eyes? Have you done a schirmers? My scores are unfortuantely quite low. 3mm yikes!

Yes, I've been doing the warm compresses as well. Three times a day, 5 minutes each time. Although, I don't know if its helping much either.

[tealeaf]

With that said, after reading about all the horror stories regarding smart plugs, I will ask to have them removed during my next doctors visit.

Chella, yes, I think is wise to remove the smart plugs to prevent unnecessary complication in future. Already with dry eyes, we wouldn't want to add more worry.

A few of my friends have been using restasis and told me it works really well so I will definitely give that a shot (hoping I can bare the massive burning).

I have used restasis for 8 months; no burning and is comfortable to my eyes when I put them in, I keep the vial in the fridge.

Good luck with the plugs. It's definitely not for everyone. I not only have evaporative dry eye...I am also not producing enough tears..so plugs aren't really helping much

I have evaporative dry eye plus insufficient tears too. I hope I will get used to the plugs after a few weeks. You may want to do warm compress and lid scrub to help you in the lipid layer to improve evaporative dry eye.