Plugs

[odydnas]

Hey everyone,

When are plugs a bad idea? I have MGD and allergies...can plugs make me worse, or should I just try them?

Thanks!

[indrep]

If you have good aqueous production and adequate tear break up time, plugs would probably not be very beneficial for you. Are you currently keeping your eyelid margins clean? However if you have the problem for a long time and are experiencing inflammation that is reducing your aqueous flow then plugs could help reverse the inflammation environment and ultimately over a few months reduce the inflammation.

[odydnas]

I have good aqueous production, but not so great TBUT. My mgd is weird in that you don't see any clogged glands, but no oil comes out of my glands. I had a lot of inflammation, but steroids helped a lot and I am currently on Restasis, which I think maybe beginning to help. My optometrist has really been pushing for it, but I had just asked Dr. L if plugs is a good idea for me and he preferred me not to. I think I will stick w/ Dr. L's opinion =)

Hm..I thought that plugs were a bad idea if you had a lot of inflammation?

[rubyslippers]

I had horrible, really horrible inflammation that would not even respond to steroids. I am very, very prone to bouts of inflammation. We don't know if I have eyelid blocks but doing Dr. Latakany's Eyelid Spa (like a scrub) does make me much more comfortable. I never see anything coming out but if I don't do it I have a rough day. I neither make good tears, nor do I make enough. The plugs made a huge difference for me.

[indrep]

odynas
What causes inflammation is hyperosmolarity of the tear film. Hyperosmolarity comes from two sources 1) not enough aqueous which increases the salt concentrations on the ocular surface, 2) MGD or lack of lipid production which increases evaporation leaving high concentration of salts, etc. on the ocular surface. Either way, the ocular surface becomes inflamed. Studies have shown that 75-80% of people who have plugs and and a two week dose of topical steroids are free of symptoms and signs at two months. What punctal occlusion does is increase the amount of aqueous on the ocular surface reducing the concentration of salts reducing osmolarity and reducing the proinflammatory environment. Punctal occlussion is not an immediate "cure" it takes several weeks for the ocular surface epithelial cells to regenerate. Also if your meibomian glands have atrophied you may have symptoms in varying degrees for a lifetime, this would also be the case if lacrimal production of aqueous is impaired permanently.

[EllMitcho]

indrep - thanks for your post, it has made the role of plugs clearer in my mind - I may well try them

Thanks

EllMitcho