Considering flow contollers

[LasikLady]

I am considering getting flow controller plugs in the bottom punctum. I have been totally plugged for almost 6 months. I still have dryness in the morning which I didn't really have before I had my uppers done. That mystifies me. Why would being totally occluded increase morning dryness? But after about 20 minutes after being up the good old tears kick in and then the blotting starts. It has gotten way better than when I first had the uppers in. But still some days I need to blot very often, other days I don't have as much tears and blot somewhat less. I still have slight, slight burning every now and then. Much improved from before. I can watch t.v. and read at night and though I have to blot I can do it a lot more comfortably. I am concerned though about removing my conventional plugs in the bottom and trying the flow controllers. My doctor has said removing the uppers are not an option because the are inside the canals and he won't irrigate them for anything. And I don't want him to either. I have never had a plug fall out and except for the beginning soreness, my plugs don't bug me at all. Should I leave well enough alone? The blotting bugs me because it makes me have to think about my eyes a lot. My insurance won't cover the flow controllers and I'm told they're about 60 bucks an eye. I really don't care that much about the money but I'm scared if they don't work and I need to go back to my regular plugs that I won't get as good a fit or something may go wrong and I've been so lucky with them so far. Does anyone have any advice for me? Should I just be happy with my improvement even though I can't be without a tissue around? Should I go for the flow controllers and hope for the best?

[indrep]

As for removing the current plugs and inserting new ones you run the risk that the sphincter of the punctal ring cand be ruptured andthis will directly affect the retention of the new plugs.

[LasikLady]

So it sounds to me like you are saying I should leave well enough alone? How often does this happen that a rupture occurs? Is this a large risk?

[Lucy]

Lasiklady, way back in time, a few years after my Lasik, I had plugs in all 4 ducts and I still had dry eyes. I was still working full-time and had tear overflow all the time. Mostly when ever I'd talk to someone, smile or some such thing. Always blotting. I chose to let things be as Indrep said. I've really stretched out my ducts and they are mostly scarred shut now after repeated plugging/unplugging.

My major problem did resolve itself (the overflow) and I hardly noticed it. It was not anything I did, or didn't do to change it. I still have overflow in one eye now 9 years later. My Schirmer's are zero in both eyes, but only overflow in one. Go figure. I'd vote for you to leave things as they are. Lucy

[indrep]

So it sounds to me like you are saying I should leave well enough alone?

I am saying be aware of what might happen with removal and reinsertion of plugs. My wife is quite happy to plot tears to have tears on her ocular surface, but for some people that is too big an incovenience.

How often does this happen that a rupture occurs? Is this a large risk?

These two are doc dependedent. For those docs who gently rock the plug back and forth as they remove it, they probably have a low rate of rupture. However the sphincters can soemtimes be quite fragile and the least little stretching can be too much. Unfortunately there is no way to test it before doing the procedure.

[LasikLady]

Thank you Lucy and Indrep for your great responses!
One thing I have felt lucky about through this whole ordeal is that I got a perfect fit with all 4 plugs from the get go. Never has a plug fallen out and I have even forgot and rubbed my eyes once or twice. The blotting is a pain, but has gotten some better than in the first few months.
Indrep you talk about the skill of the dr. being a determining factor. That is the thing too, this is a new doctor who does not seem to have very much experience with puntcal plugs. He asked me to research which flow controller plug to try and flat out told me he has never inserted a pair or known someone who has tried them. I just do not have a lot of confidence in him. Rolling the dice and taking a risk was what got me in this situation to begin with. I was totally uninformed and misled by the lasik surgeon. I think this time I am leaning toward leaving myself alone and dealing with what I have knowing that what I might get if I try something new could be much worse.
Thanks for the info, and the help in making an informed decision.