Can the plugs go beneath the surface?

[Treasure]

Hello. I had punctal plugs put in the lowers 11 years ago. Lately my eyes have been bothering me a lot and I had the sense that the punctal plugs were the cause of it. So I went to the doctor who originally put them in and when he looked at my eyes he claimed that the left one was gone. Then he pressed his finger in that area and I could feel it in there. I asked him if it's possible that it could have somehow got under the surface and he said no it's not possible because they have a "mushroom" head that prevents that from happening. Then he pressed on the other side and I could feel one too but higher up. When he pressed on the left tear duct he asked if it felt tender and it did. Then he asked about the right one and I said a little, but not much. Then he claimed "it looks like you're getting a chaizon" (sorry I don't know how to spell it) in the left eye. I don't believe it! I haven't seen anything like that and I had looked all around my eye lids with a magnifying glass before going to the appointment. What I think happened is that when he originally put them in, he pushed the plug too far and it ended up below the surface and now it's stuck in there and I want it out. My question is whether there's any way to tell for sure that it's still in there. I have a hard time believing that it fell out because I had him take the right one out (despite smelling alcohol on his breath!) and it was difficult to remove and I felt it pop out after he tugged it. I don't believe one of these could just fall out. They have been in there 11 years. I'm at my wits end with the dry eyes. I want new plugs because I use a CPAP machine at night and all this started with the CPAP, the air travels up through the drain that's connected to my nose and dries my eyes out. The plugs helped that. I can't sleep without it because I have very severe apnea. Please, do you know if there is a non-invasive way to tell if the plug is still in there??? Obviously I'm going to find another doctor, no way I'd go back to an eye doctor that smells like whiskey.

[Guest]

I had the same problem. One plug that I had in for 10 years suddenly disappeared. When the doc tried to place another one there, it would not go in, no matter how hard he pushed and what size he tried. He sent me to a specialist who said that as long as it does not get infected, leave it wherever it is. He did not want to cut open my tear duct to see if the plug was indeed there. Since I really wanted another plug, the new ophthalmologist I found tried to place one in the upper duct. It was too uncomfortable so she took it out 4 days later. Unfortunately, I am not aware of any way to determine if a plug has migrated. They don't show up on x-ray is what I have been told.

[GingerBee]

I know this is an old thread, and multiple people have asked the original poster's question before, but I thought I'd bump this to the top again to see if anyone new has anything to add to it. I just got plugs put in a few days ago, and I can clearly see and feel one plug, but not the other. I don't know whether it fell out on the way home from the eye doctor or whether she just pushed it in too far. I guess I should probably just go back for another appointment. Or should I try to find someone else with some kind of special expertise?

[Rebecca Petris]

Wow, I never saw the post from 2019 unfortunately.

Yes it most certainly IS possible for punctal plugs to go beneath the surface, and to migrate. I have known of many cases, including some where when a punctal plug was removed, a fragment broke off, fell in and migrated. On the other hand, the OP's doctor mentioned chalazion, and while I understand OP did not have confidence in their dr, it's still possible that that was the explanation.

The best resource for plug complications is an oculoplastic specialist. They are ophthalmologists with expertise in eyelid surgery. They are the ones with the most experience in assessing plugs that have gone awry in some way.

Poster #2 is right in saying that plugs do not show up on x-ray. They are "radiolucent". There is no imaging technology that can track them down as far as I know. It's always far more likely that a punctal plug fell out than migrated inwards but if I were you I'd call the doctor, explain, and ask to come in again. They can assess it, decide whether to irrigate and whether to replace it.

Note: Punctal plugs are sometimes treated somewhat casually in both optometry and ophthalmology, IMO. For reimbursement purposes they are considered and in-office procedure and as such, we are supposed to be given informed consent before this is done. As far as I can tell, that's not often actually done. IMO there should always be a discussion of plug options including dissolvable rather than silicone types.

[GingerBee]

I have an appointment today actually with the doctor who put the plugs in. I'm not sure what to do if she wants to try to flush fluid through my lacrimal system to see if the plug comes out. I don't want it to end up somewhere where it's completely irretrievable. I feel like it's still in there because I have the same tender sensation around the tear duct as the OP. Also, the doctor dilated my punctum (twice in a row) to fit the plug, rather than choosing a plug to fit the hole, so I imagine it was pretty lax when the plug went in. I wish the OP would come back and report on what the outcome of their situation was.

I just read on the Internet that using 20-MHz ultrasound can visualize where the plug is. That would be very helpful, but I wouldn't know where to go to find a doctor with the right kind of ultrasound. I guess if I'm not satisfied with the outcome of my appointment today, I'll try to seek out an oculoplastic surgeon. I'm going to also ask to have my remaining plug removed since it's irritating and definitely not worth the worry! If anyone asked me whether I'd recommend plugs, I'd definitely say no, unless your situation is completely desperate, which mine certainly wasn't.

[zoso967]

I know this is an old thread but I am going through some plug issues right now.

It seems I have several umbrella type plugs migrated into the canaliculus on both lower lids. Several have been taken out of both sides. They tried to flush the others out but they're stuck.

2 oculoplastic surgeons told me to leave them alone if they're not causing me problems. I am concerned that eventually they will cause me problems.

Ironically, the one on the right seems to have stabilized my symptoms but the one on the left has not and that's my better eye or at least it was. Even though my left one is completely blocked that eye gets very dry without a plug.

My only guess is it's blocked further down and the tears fill the space & don't reach my eyes.

One oculoplast said he won't cauterize it or it might cause an infection. The other said he would cauterize it and it would not get infected because it'll be blocked so nothing would get in there to infect it.

I honestly don't know what to do but I'm miserable right now.

My take on plugs is they can be very helpful IF used correctly. My Dr never measured & put a bigger plug each time one fell out. So my puncta are all stretched out of shape and very large.

If anyone knows of a good oculoplastic surgeon around NYC/Long Island area with experience locating & removing plugs I'd appreciate the reference!