The curious case of my punctal plugs

[kitty]

I have Herrick intracanalicular plugs, got them about 3 years ago. I'm double plugged in the left, single plug in the right. About 3 months ago my DES symptoms got worse and I could no longer see my plugs. I had my annual eye exam last Monday and that Dr. could not see the plugs with translumination. I saw my dry eye doc today, he could not see the plugs with translumination. He irrigated. He probed. He scratched his head. He is pretty sure the left upper is gone (irrigated freely). He can't tell if the left lower is there or not (some irrigation fluid got through, he felt obstruction, not sure what it is). He thinks the right lower is still there. He offered me more plugs, surface type this time. I told him I was not entirely comfortable using more plugs not knowing for sure where the other ones are. He said he isn't either. He said he was afraid of getting too aggressive with probing out of fear of perforating my canals. He is sending me for a 2nd opinion with an oculoplastic surgeon, Dr. Steven LauKaitis, MD in Kirkland, Wa. Rebecca knows of Dr. LauKaitis, he used to see a lot of DES patients. Now his practice is limited to oculoplastic and cosmetic surgery. I feel very fortunate to be getting in to see him ( a 3 week wait). I'm hoping he can shed some light on my DES or refer me on to an ophthalmogist who has more than a passing interest in DES. I'm frustrated but happy at the same time. I now have a bit more respect for my DES optometrist for taking the initiative in referring me on.

[indrep]

Kitty you have a great optometrist. Hopefully the oculoplastic doc will have enough experience to give you a more definitive answer.

[kitty]

Update

I just wanted to post an update. I saw the oculoplastic surgeon today. He said both left plugs are gone. He cannot say with 100% certainty that are not still in my lacrimal system somewhere, but they are no longer occluding. My right lower is probably there but has migrated and may very well be encased in scar tissue. That one may need surgery to remove if it gives me any problems. For now it is watch and wait. He also diagnosed ocular rosacea.