Plugs and MGD

[Maria1972]

My main problem is bad MGD (glands). Even though I do compreses 4 times a day they are clogged most of the time. I have plugs on my lower lids.

My dr is hesitant in doing the upper plugs because he thinkss it'll cause more inflamation.
Has anyone got worse with plugs????

I'm wondering if plugs are only for special category of DES sufferers.

[indrep]

Maria,
Plugs are not for special DES patients. I read a study yesterday that showed patients with MGD actually have a more rapid rise in the osmolarity of their tear film than those with Lacrimal Gland Dysfunction. Increasing tears has been shown to decrease the osmolarity of the tears, reducing osmolarity has been shown to reduce inflamation since it is the increase in osmolarity that started the inflammation.

As I am the curious sort, does your doc prescribe Restasis often?

The nutritional supplements along with dietary changes might help with the "flow" from your meibomian glands. You might could suggest to the doc that you want the 90 day plugs inserted in your uppers and let you decide if your eyes feel better.

[Helen26]

I have MGD and a lot of inflammation in my eyes. I did have plugs put in but they fell out and I haven't got them replaced yet because I was worried about them trapping the inflammation but maybe I should give them another go. However, when I had the plugs in I got conjunctivitis several times and now I have blepharitis too so I didn't know if this was due to the concentration of bacteria in my eyes being trapped by the plugs.

My main concern though is the inflammation - I need to get this under control. Any suggestion????

[indrep]

Helen,
You have four puncta that allow tears to flow off your cornea and conjunctiva. When two puncta are occluded you still have two puncta left for removing tears from the surface of your eye. I heard a speaker last week say that "Tears are necessary to remove bad things from the eye" . He was referring to the inflammatory elements. There are many types of punctal occluding products available to doctors now. Maybe suggest the 90 day plugs and see how that goes or the Flow Controlling plugs that would reduce the outflow.

Unfortunately one company is speding millions of dollars to talk about inflammation in tear film and on the eye. There is a very small percentage of people who suffer from the type of DES that that drug was designed for. The many patients that are suffering from too few tears to lubricate and bring some relief from this horrible condition is sad. If the docotrs and patients would just read the product insert included with that drug then maybe we could move forward with other treatments that could benefit more of the population that suffers.

[SusieD]

Maria,
Plugs are not for special DES patients. I read a study yesterday that showed patients with MGD actually have a more rapid rise in the osmolarity of their tear film than those with Lacrimal Gland Dysfunction. Increasing tears has been shown to decrease the osmolarity of the tears, reducing osmolarity has been shown to reduce inflamation since it is the increase in osmolarity that started the inflammation.

As I am the curious sort, does your doc prescribe Restasis often?

The nutritional supplements along with dietary changes might help with the "flow" from your meibomian glands. You might could suggest to the doc that you want the 90 day plugs inserted in your uppers and let you decide if your eyes feel better.

So occlusion can be beneficial for people with MGD issues then and not just those with pure lacrimal deficiency.

Well I am testament to that anyway - I have MGD yet I always feel more comfortable when occluded. Unfortutately I dont have a good history with any of the plugs used.

[Maria1972]

Susie waht was wrong with the plugs?

I have an appointment on the 13th of this month, dr will check my eyes and we'll decide about the plugs. I will ask him for temp plugs.
I don't know if one of my lower plugs was ver there anyway b/c I never saw it. It was put by a resident and he indicated that the plug is inside. How can I know if the plug is there?

[Guest]

We all have different experiences with plugs.

I had the oasis 90 days in both top and bottom at one point and bottom only at another.

My dr then put in silicone ones in both top and bottom and I had overflow like mad (not forgetting to mention the horrible sensation of stabbing my corneas when I looked in the wrong direction).

I now have Oasis permanent (or long term as my DR referred to them) in the bottom lids only and find these are just the right amount (early days, my eyes still get dry but nothing like they did previously). I wish I went for the "long term" option months ago, maybe I wouldn't have had half the problems I had with Dry Eyes.

I am convinced that the Oasis 90 days were not suitable for me (3 of them fell out). At least with the new ones I check them every morning and night and feel much happier and more comfortable.

For me, two permanent plugs beats 4 temporary ones anyday.

Take care

Ian

[Maria1972]

Gosh...I called my doctor today and he wants to try doing eyelid escrubs first. I've never done it. I told him My upper eyleids are full of clogged pores. The lower have just a few.
I'm trying to push for the upper plugs, at any case he'll like to try the temporary ones first. B/c I already have lower plugs...

[indrep]

Meibomian Gland Dysfunction patients typically are worse upon waking in the morning.

Lacrimal Gland Dysfunction's symptoms worsen throughout the day because the tear osmolarity increases throughout the day.

Meibmoian Gland Dysfunction is worse in the morning because the inflamed lid has been in contact with the cornea all night. As the day progresses and tears clean the surface of the cornea the irritation lessens.

Upper plugs may not be as beneficial to you as the lid scrubs. Insuring you have a free flowing meibomian gland is very important to helping you.

[Maria1972]

I think I have both MGD and lacrimal, as I'bad in the morning and then I get worse as I get closer to the evening. Well the whole day really.