Plug Question

[Vijay]

Hello everyone.

I recently had lower punctal plugs put in but found little improvement after six weeks. So then the opth. put an upper plug in the right eye, and my right eye is now much better during the daytime. Blinking is a lot smoother now and I feel a difference between the left and right eye. It's strange, I didn't feel so much irritation in my left eye before, probably because the right was worse, but now the left is worse. I still experience nighttime dryness in my right eye, but not as bad as before. There is still some soreness/pain probably from minor RCE's or at least some sort of irritation to the cornea from eyelid sticking.

My question is: do you guys think I should get another plug in my left eye? I experience dryness during the day and night, but I have not had any pain in quite a while now. I am also on restasis (for about 2 months now) and use tranquileyes and ointment or gel at night. I appreciate any feedback.

Vijay

[calli66]

How long have you had the upper plug in your right eye? The reason I ask is because I also tried upper plugs, and they felt good for the first week only. After that, I had problems with the extra moisture causing skin irritation of the lids and inner corners of my eyes. After 5 weeks, I had the uppers removed, and now I'm doing better.

But there's no harm in trying upper plugs, because if they don't work, you can have them removed. The extra tears may be just what you need to feel much better.

Even with all 4 puncta plugged, you can still expect to have some nighttime dryness.

Calli

[Vijay]

calli,
The upper has been plugged for about 3 weeks now. I have noticed that the pain is in the upper part of the eye in both eyes, but it has faded in the right eye for the most part. Perhaps it will resolve completely now that I am lubricated all the time (at least during the day). I'm thinking that before the upper plug, the tears were draining away exactly where they were needed in the top part of the eye.

My concern is any risk posed by the use of plugs and whether or not the cause of my dry eye is being addressed. If there is a way to restore tear production, I may be missing out on it if I am completely plugged. I was actually thinking about going to see Dr. Latkany since I am going to New York City anyway. I would really like to know if my current opth is missing something.

Vijay

[kitty]

You might try a 3-6 month plug before going to a more permanent type. One thing to remember with having both uppers and lowers plugged is this. When you get reflex tearing due to dryness, allergies, or anything else, or when you cry, there is no place for the extra tears to go except down your face, unless you have flow controller plugs. Just some food for thought.

[calli66]

Vijay,

You mentioned pain in your eyes--I don't know if it's the same thing I experience---I get mine sort behind the eye---in the orbit / eye socket. Especially in my drier eye. Like a headache, this eye ache can start during the night, and continue on---lasting all day.

I asked my eye doctor about that pain---he basically said that it occurs because of the dryness (no details as to why, unfortunately). But that it didn't indicate anything serious in my case. He has dry eyes himself, and gets the eye pain, too---I'm more likely to believe him since he has dry eyes.

I don't think there is a big risk in having plugs---what worries you about this? I'm not sure I understand. If your doctor is experienced and skilled in the insertion, and if the heads of the plugs don't irritate the eye, then overall, plugs are low-risk, because they can be removed later, if necessary.

I think you're wise to seek the cause of your dry eyes, and to pursue an increase in tear production, if possible. I don't know whether having all four puncta plugged would prevent the lacrimal glands from improving later on. I suppose if there is some evidence that the "secretion signals" within the eye system would be blunted if the eye surface were adequately moistened (and thus go "dormant"), then I might hesitate to go for the upper plugs.

However, I think it's almost more important to treat the dryness now---to prevent damage to the cornea, and to prevent inflammation cycles (which might affect the oil glands, or even encourage infections).

Calli

[Vijay]

calli, my eye pain is sort of at the top part of the eye, but it distinctly feels like it is in the eye (not the my head). If I touch that part of the eye with my finger, it feels tender. When I close my eye, and touch the eyelid, it appears to be the area just above the cornea. I think we might be talking about the same area. That is why I think the upper plug is helping in my right eye, keeping it moist in that area, instead of losing the tears to drainage.

calli, you said you tried upper plugs, did you also have lowers?
I'm just wondering because I do have some overflow in my right eye since getting the upper plug (but not too bothersome), and was wondering if perhaps in the future I should have the lower removed. The reason why I would want to have the lower removed is because I did not get any relief when I had the lower one alone.

I don't have any legitimate concern about being fully plugged, but being the skeptic that I am, I was just concerned that there might be something I am not aware of in my particular case. It just seems strange to be interfering with the natural process of tear drainage. Yes, it did occur to me that I might produce less tears if my eye is already moist from being plugged, but like you said calli, it's important that the dryness be treated now.

My appt. is tomorrow and I think I will go ahead with the additional plug for the left eye.

Thank you for your responses and I will let you know how things turn out.

Vijay

[calli66]

Vijay,

My eye pain is just where you described yours.

I got lower plugs in April 07, and they didn't seem to help much (but I was still wearing contact lenses then). I got upper plugs at the beginning of October, and at first thought they would be fine. I didn't have overflow except a small amount occasionally, but it was enough to keep my lids and inner corners of eyes too moist. I quit wearing my contacts at that time also, so my eyes had lots of adjustments to make. I think what happened was that once I quit wearing lenses my tear film stabilized and I didn't need the upper plugs to be comfortable.

The doctor said that the lower ducts drain 80% of tears, while the uppers, the other 20%. So even if the lower plugs don't feel like they're doing much, they probably are.

Having all 4 plugs trapped too many irritants--for me. But they might work for you. Some on this forum use the flow-controller plugs for the uppers, but I've never tried that.

Calli