plug question... or is it just nothing?

[Julie1]

Hi everyone!

I've been doing very well lately except I've been having some problems with my right eye. I've got a lower silicone plug that has slipped down so that I can no longer see it. I don't like not knowing if the plug is still in my eye and having to judge by the amount of tears as a measure of whether the plug is still there. My doctor tried to irrigate it out back in November but determined that the plug is there to stay. He wanted to be sure that the plug was gone before putting something over the plug.

In the last couple of days or so, I've recently been experiencing some redness around the area where the plug is lodged. The entire lower eyelid is also pretty red and kind of burns. My left eye does not have this redness around the plug, and the plug is still visible. Is it possible for the skin or conjunctiva to be infected from a plug that has migrated downward? Both eyes have also been itching quite a bit in the last couple of months, and I discovered the redness when I was checking to see what could be making my eyes itch so much. I've also been checking this area quite frequently once I discovered redness and tried to push the plug out last night because I thought I saw the head. I tried to push it out for a good half hour to hour. Maybe that's making that area red, and I just need to let it heal? My rims and inside lids are usually red, but it seems weird that I have this red area in the right eye but not the left eye around the area that extends from the duct down to the fold and towards the nose.

Any possible explanations? I'm pretty sure the plug is still there because I have plenty of tears and even have to blot at times. I've had the excessive tears since this summer. I also still have the cooling effect that is expecially driving me nuts in the right eye today. I have extra tears but the eye still feels nasty.

Thanks for any advice! I appreciate it!

-Julie

[Rebecca Petris]

I've got a lower silicone plug that has slipped down so that I can no longer see it....
In the last couple of days or so, I've recently been experiencing some redness around the area where the plug is lodged. The entire lower eyelid is also pretty red and kind of burns... Is it possible for the skin or conjunctiva to be infected from a plug that has migrated downward? Both eyes have also been itching quite a bit in the last couple of months...
I tried to push it out for a good half hour to hour. Maybe that's making that area red, and I just need to let it heal? My rims and inside lids are usually red, but it seems weird that I have this red area in the right eye but not the left eye around the area that extends from the duct down to the fold and towards the nose.

The pushing is probably contributing but it sure sounds suspicious based on your description. If your doctor has nothing else to say about it it might be worth going to see an oculoplastics specialist. I'm biased from hearing too many nasty plug stories but honestly, if it were me, I would not ignore this.

[Rojzen]

cooling/menthol sensation despite profuse tearing

I agree with Rebecca about getting a specialist to determine exactly where that plug is. . .I don't recall whether you have had difficulties with the old-fashioned plugs that stick up enough for them to be easily removed. . .but I do know that my eye doc in Ohio has gone back to those, after a case or two involving newer (possibly intracanalicular/sp?) ones that she could retrieve only after extensive flushing . . .

On the cooling sensation, I've posted a query to Dr. Holly on this question. . .I remember when I was quadruple-plugged, I would still get the menthol sensation, and possibly had it more intensely than when I've not been plugged at all. . .Possibly Dr. Holly will post something about why the eye surface may feel cool. . .This may have something to do with true wetting of the epithelium, versus flooding the surface with fluid that doesn't really wet the cells. . .If anyone could figure this out, it is Dr. H. . .I do know, from Dr. Holly's writings, that, in general, he sees merit in plugs. . .but possibly the increased tear volume that results from plugging needs to be carefully complemented with the right oncotic pressure and nutrients. . .

[Julie1]

I just made an appointment for Friday at 11:30 to go see my corneal specialist. I hope that he's able to flush the plug out and that I do not have an infection. I don't have any pus or yellow drainage just a red area that goes down into the fold and towards the nose. My eye really doesn't hurt; I just noticed the red area when I was trying to determine why both of my eyes itch. The itching has been going on for quite a while now and no one can figure it out.

I do have the old fashioned plugs but somehow the right lower plug slipped down into the canal sometime this past fall.

I obviously don't want the doctor to put another plug on top of the one that is lodged in the canal. Is there anything else that I should be wary of?
I just want to go prepared because sometimes I feel like I cannot trust the doctors.

Thanks!

Julie

[bassfan]

I remember when I was quadruple-plugged, I would still get the menthol sensation, and possibly had it more intensely than when I've not been plugged at all. . .Possibly Dr. Holly will post something about why the eye surface may feel cool. . .

Evaporation of water on skin causes skin to be cool...same thing should happen to the eye. One of my main DES symptoms is very cold feeling eyes...tears evaporating too quickly.

bassfan

[Rebecca Petris]

I do have the old fashioned plugs but somehow the right lower plug slipped down into the canal sometime this past fall.

It's unusual but I think somebody posted about this having happened. Maybe it was DrG, I forget. You might want to PM IndRep about it. My concern would be... just like I worry about intracanaliculars... having a bit of silicone slowly migrating someplace it was not meant to go and from which it could be very difficult to extract it. I would take the irritation/itching as my body telling me hey we got some unwanted foreign object here, would you please come get it before it really makes itself at home?

[shells]

It's unusual but I think somebody posted about this having happened.

It was probably me!

Julie - I have had punctum plugs (with the cap) migrate down as well. Actually, my inexperienced doctor forced them down since I was complaining of the scracthing, but let's not get side tracked . When I realized what she had done, I called immediately for an explanation. To make a long story short, she ended up having to call the company (I think they were Oasis plugs) to figure out what to do about it. Their advice was to either leave it there (since it would still be effective) or just flush it out like you would a regular intracanalicular plug. I DID NOT want them to stay there due to possible complications, so I had her flush them out. After all, if I had wanted an intracanalicular plug, I would have asked for an intracanalicular plug. I stopped seeing that doctor immediately, and saw a new doctor the next week. She was shocked at what had happened, and referred me to an occuplastic surgeon just to make completely sure the plug was gone before inserting a new plug. I was not having any pain/swelling/pus, etc. so the specialist just flushed me with saline again, and things were flowing freely, so she deemed that the plug was out.

I'm glad to hear that you got an appt. so quickly, and I hope you get this all straightened out. I'm not sure why your doctor said that the plug was there to stay after trying irrigation? Did he determine there was still a blockage since the saline did not run down the back of your throat? If that is the case, then I agree with Rebecca that you might want to see an occuplastic specialist just to make sure that the plug gets removed correctly. I believe if necessary they can probe to determine where the blockage is. Good luck!

-Shells

[Julie1]

Rebecca and Rojzen - Thanks for your advice to go see someone about this plug problem. I think I saw some whitish discharge come out of the puncta this afternoon, which is definitely concerning!

Shells - Thanks for your story and your advice to take care of this problem.

I'm not sure why your doctor said that the plug was there to stay after trying irrigation? Did he determine there was still a blockage since the saline did not run down the back of your throat?

My doctor said that it appeared that the plug was still there because the saline backed up the puncta and did not run down my throat. At the time, I was not experiencing any problems so it was just easier to leave it. I think there is a possibility that there might be another plug in addition to the one in question. The first doctor that I saw when my dry eye started really didn't know what he was doing, and he may have actually complicated the situation. I had one set of lower plugs fall out, and he immediately inserted another set without trying to irrigate the plugs. This could explain why the right plug is not easily irrigated out.

I hope that everything works out okay. I'm kind of scared. I have been doing really well and haven't really been using a lot of drops and the pain has been minimal. I've even been wearing some eye make-up and haven't thought about my eyes 24/7. I hope that I can resolve this problem quickly without any significant complications.

I'm trying to restrain from pulling my lid down to examine the inner corner of my right eye, since that probably makes the inflammation worse.


Bassfan - I hope you're doing well in Fort Worth! How are your eyes? Are you trying the DHEA drops?

-Julie

[shells]

Hi Julie,

So glad to hear that overall you are doing better! Don't let this plug thing scare you too much, plug complications are rare. What is important is that you realize the plug may still be in there, and whether or not it's cauisng a problem, it would be best to remove it and start over with a new plug if that is what you want. Maybe with your recent improvements you won't even need a plug in that eye! Hopefully your doctor will be able to help or refer you to someone who can. Good Luck and keep us posted!

-Shells

[bassfan]

Hey Julie

Im doin alright down here. I have been maintaining anyways. Haven't had a really bad day in a couple weeks. I am worried about when it starts to get warm and the AC is on though.

I am going to try the DHEA drops, hopefully should get them next week at some point.

Have you moved yet? I hear its quite cold in NE!

bassfan