To Have Punctal Plug or Not

[WendyE]

Hello!

I am hoping some experienced patients or doctors can give me some input to make a more informed decision.

I saw my eye doctor this morning for a follow-up to my visit 10 days ago when he prescribed Alcon drops for my corneal abrasions. It was a frustrating appointment for me as he doesn't seem to answer questions very well. He is sure that my dry eye is all a lack of oil and yet he says I have seborrhea. I asked if he saw skin flakes or greasy residue on my lashes and he said no, it's dry. I don't understand.

I specifically asked about my TBUT and the right eye is at 3 and the left (most symptomatic) is at 2. I didn't use the Alcon drops very much at all as they stung quite a bit. I did use Nutra-Tears, Dakrina and Dwelle quite a bit though and have been doing lid scrubs for a week, and the abrasions were gone.

He mentioned he might want to try a lower plug in my left eye next time to see if it would help. I am confused. If it is a MG dysfunction, what good will a plug do? Will a plug raise my TBUT? My left eye has been tearing for years. Usually, it's not enough to drip down my cheek, but it leaks along the crease in my lids and sits there leaving a salty mark. Will a plug make that worse?

My first instinct is not to get a plug. I do not really trust this doctor's opinion on anything thus far. I asked him today about lid scrubs and such for the seborrhea and he said they don't do any good in his experience and I shouldn't bother.

Can someone help me with the pros and cons of this and help me understand the anterior/posterior bleph? I thought the way he talked about lack of oil last time that I had MGD.

[Judy]

"My first instinct is not to get a plug. I do not really trust this doctor's opinion on anything thus far. I asked him today about lid scrubs and such for the seborrhea and he said they don't do any good in his experience and I shouldn't bother."

I can respond to the above as I really feel the lid scrubs I do, along with the warm rice baggy have really brought me up to a much more tolerable level with my dry eyes. Sometimes I only use drops two or three times a day now versus way way more. My eyes look better (not great, but better) and my eyelashes are in much better shape.... Just my two cents...

WendyE, I think you may need to see a new doctor, personally... This site is incrediblly helpful as well! Take care and best wishes...

[bassfan]

I'd give them a shot...plugs aren't really going to do anything to hurt you...except for the pocketbook if insurance won't cover them fully. Just get lower surface plugs to start, give them at least a few weeks for your eyes to adjust...have your doc take them out if you dont like. Simple as that.

As far as your doctor, Im all for trying multiple doctors with this DES stuff. Then again, I think this forum is more my doctor than real doctor could be. They sit with you for half hour or less...take your money, and dont worry about you after that. Not their problem, I cant really blame them but I've never felt like a doctor truly cared. If only we could give them our eyes for a day...

bassfan

[atta]

Hi,
Jury, I agree with you. If a doctor is not a specialist of dry eyes or himself a dry eye patient, he might never understand your problem.

And dry eye problem is so complicated you might need to try anything, sometimes they help, sometimes not, sometimes they help in the beginning and not any more after a while. You must try them.

[Justin]

Second opinion time. Go with your gut instincts. If you can not trust your doctor, move on. Find a more compatible eye doctor.

[WendyE]

Thank you to everyone for your replies.

The plug that would be used would be a Smart Plug as that's all that Dr. has. I would have no choices in product. It is a small Air Force Optometry clinic, so it's not like he has multiple suppliers or anything.

If my left eye gets really irritated, the lids are constantly wet/moist from tears seeping into skin wrinkles. If I get a plug, won't that become much worse? The skin gets quite sore and it seems like salt crystals build up in the creases.

[GinaJ]

Hi. I am in Ca too. I agree about other opinions I have seen 6 doc. I also was told by most I have blepheritis but then by the last I have the dermitits you are speaking of. I think they come in all extremes which is what the dermatologist told me. Have you thought of seeing one? I have been told to still do the scrub and heat compresses though. I have been told I could try the plugs or use the drops but I don't have dry eye though they feel it just the symptoms of it but still have a film I guess. The doc said the issue with the plugs is if you are allergic. Now this may be wrong because I have been told other things have no issues too. Hang in there.