SmartPlugs

[Rebecca Petris]

I tried SmartPlugs a couple of years ago (lowers only). I mostly noticed two things:

1) The insertion process seemed easier than silicone plugs
2) They were more comfortable than any silicone plug I have tried. I have only had a couple of other plug types (Eagle FlexPlugs and one other that I can't remember now) and I could always feel them when I turned my head.

I have no idea how long the SmartPlugs lasted. They are intracanalicular (nothing sticking out the top of the punctum) so it's very hard to tell. They may have lasted weeks or months and I'm just not sure.

I had no epiphora or other problems. I was not aware of any benefits. I won't rule out that they were helping me a little bit but just not giving me enough incremental improvement to be sure.

I tried SmartPlugs after having trouble getting silicone plugs to fit right or stay in. Seemed like I was in-between sizes or something. Smart plugs expand after insertion so this is not an issue with them.

[ellen]

Smart Plugs

I had smart plugs put in two days ago. Have had severe dry eye for about a year after 30 years of contact lense wearing. The left eye is much worse but the dr. says both are dry. Insertion of the plugs was painless and easy...but the left eye feels more dry not less--or maybe it is just irritated at the site of the punctum? (But not red or swollen or other indications of irritation.) I am so disappointed this was represented to me as the "fix-it" thing for my situation...or does it take a few more days and I am being impatient? Any advice would be so appreciated....

[jcorbett]

plugs

When I had my lower plugs first inserted, I did not notice a difference for several days. After that, I was noticeably comfortable. However, it is always possible you lost a plug so if you don't notice any difference after a few days, you should have it checked.
When I had upper plugs inserted at a later time (in addition to lower) I noticed immediately. My eye got very moist.

[Gogo]

I was in a clinical study for the Smart Plug

I was in a clinical study years ago for the Smart Plug. I did see some improvement in the Schirmers Testing but it wasn't appreciable. I was a little more comfortable with moisture and much more comfortable than with silicone that lasted only days or weeks. Everyone is different.

I still have an experimental "gel" plug in. The research company Alcon allowed us to keep them if we chose. My left punctum accepted it immediately and was comfortable from the moment it was place in. They conform to the shape of your own punctum. However, my right eye did not accept it well. It hurt for two weeks. It finally, "settled down". My right eye is the eye that was severely hurt with the post operative medications after cataract surgery. It was tantamount to a chemical burn. The tissue in the eye has never been the same. Consequently, months into the research my right punctum developed an infection and the plug pushed its way out. Following the healing my doctor said that I was the third to have an infection out of all in the trials and said that my infection probably put the nail in the coffin and sent it back for my research to the company.

After that he said he wasn't comfortable with anymore foreign plugs in my right eye and suggested we cauterize it close. We did that! I have felt good for about 1-1/2 to 2 years until about a month ago. As stated in another thread I don't know if its medication reaction. My doctor and I are experimenting.

[dunnrainin]

Smart Plugs

I tried Smart plugs about 3 months ago, had them in for 6 months, but didn't notice any difference in my dry eyes. My ophthalmologist decided to remove them and my eyes seemed better. They don't tear all the time but they are very dry. I decided after a year it was time to get a second ophthalmologist opinion and the first thing this doctor recommended was putting Smart Plugs back in. I don't know what to do. I guess I would rather live with them a little dry and use drops all the time than to have then run constantly. Anyone else have this experience?

[jcorbett]

I have heard they make some new plugs that allow a little drainage for situations like yours. Sorry...I don't know what they are called, but perhaps someone else would know? Or perhaps your doctor?

[Rebecca Petris]

Probably referring to Flow Controller Plugs by EagleVision.

[Annie]

I had smart plugs put in two days ago. Have had severe dry eye for about a year after 30 years of contact lense wearing. The left eye is much worse but the dr. says both are dry. Insertion of the plugs was painless and easy...but the left eye feels more dry not less--or maybe it is just irritated at the site of the punctum? (But not red or swollen or other indications of irritation.) I am so disappointed this was represented to me as the "fix-it" thing for my situation...or does it take a few more days and I am being impatient? Any advice would be so appreciated....

Hi, I have punctal plugs in lower tear ducts. I did not notice relief after they were inserted, it has been several years now. I have had so much done I am so tired of wondering when the next severe dry event is coming. Annie

[DrG]

I was in a clinical study years ago for the Smart Plug. I did see some improvement in the Schirmers Testing but it wasn't appreciable. I was a little more comfortable with moisture and much more comfortable than with silicone that lasted only days or weeks. Everyone is different.

I still have an experimental "gel" plug in. The research company Alcon allowed us to keep them if we chose. My left punctum accepted it immediately and was comfortable from the moment it was place in. They conform to the shape of your own punctum. However, my right eye did not accept it well. It hurt for two weeks. It finally, "settled down". My right eye is the eye that was severely hurt with the post operative medications after cataract surgery. It was tantamount to a chemical burn. The tissue in the eye has never been the same. Consequently, months into the research my right punctum developed an infection and the plug pushed its way out. Following the healing my doctor said that I was the third to have an infection out of all in the trials and said that my infection probably put the nail in the coffin and sent it back for my research to the company.

After that he said he wasn't comfortable with anymore foreign plugs in my right eye and suggested we cauterize it close. We did that! I have felt good for about 1-1/2 to 2 years until about a month ago. As stated in another thread I don't know if its medication reaction. My doctor and I are experimenting.

I have a colleague who is an oculoplastic surgeon. His practice is limited to lacrimal system reconstruction and eyelid reconstruction following cancer, etc. His words of wisdom were as follows: "Don't ever assume that whatever you insert into the nasolacrimal canal can be irrigated out." This comes from somebody who has had to perform countless dacryocystorhinoplasties as a result of imbedded inserts.

My philosophy is that I want to be able to see the plug. If I don't see it, then I know it fell out. Sometimes the flange of the plug can be irritating. There is actually a way of removing the plug and trimming the flange with scissors or a scalpel, and reinserting it. Or one can start with a new plug, trim the flange, and insert it.

DrG

[spaniel]

DrG- Are you suggesting that the "gel" of the acrylic hydrogel of the various newer type of plugs can remain lodged in the lacrimal sac, migrate,etc and cause problems that haven't really been discovered yet?
Do you believe that they simply can't be flushed out?
I'm asking here because I'm post transplant of 3 yrs and have problems getting the RGP to fit comfortabley. But I had a nasty time with a silicone and after some major effort,had it removed. But my doc still wants me to have a plug- and sorta suggested one of the gel types.... I'm hesitant. And I don't like the idea of cautery... at this point the word permanent sacre me.
I do thank you for any response.

[DrG]

There are two kinds of plugs: intracanalicular and punctal. Intracanalicular implants slip into the horizontal portion of the lacrimal canal. The punctal plug is designed to close the punctal opening, but has a flange to keep the plug from migrating into the canal.

I think that any intracanalicular plug carries with it some risk of migrating further down into the lacrimal drainage system and getting stuck in the lacrimal sac where they can cause inflammation or infection. The problem with all such plugs is that they are difficult to identify once they have been inserted. The major problem with punctal plugs is extrusion, i.e. they tend to fall out in about half the cases.

While I am unable to find any literature on complications with the Medennium plug, I still follow the advice of my lacrimal surgeon friend who cautioned me about sticking things into the lacrimal canal. I think the risk of the gel plug is probably going to be less than with the silicone variety. Only time and experience will tell. I use the Parasol plugs by Odyssey.

Wow, I'm watching the fireworks tonight from the upstairs window where I am typing this. Happy Fourth of July.

DrG

[spaniel]

Dr G- thank you for your reply. Yes, I too have been trying to find info on "longer" term complications with the Meddenium or Oasis gel plugs. I can find nothing (I triedPubMed/ProQuest,etc).Here's an odd question: Where can one find data from the clinical trials? I feel I should know this, but...don't.

[DrG]

Dr G- thank you for your reply. Yes, I too have been trying to find info on "longer" term complications with the Meddenium or Oasis gel plugs. I can find nothing (I triedPubMed/ProQuest,etc).Here's an odd question: Where can one find data from the clinical trials? I feel I should know this, but...don't.

The FDA maintains a website for medical devices. It has a useful search function.

DrG

[Peggy]

Removal of smart plug

I had the smart plug put in on Friday at Wills Eye Hospital 4 hours from my home... I can feel it and it is bothering me...A local opthamoligist is not crazy about removing it but will do it if I want him to this is just one more thing I am having to deal with. The local dr. has put the smart plugs in but never had to take one out. He cannot believe that I can feel it. I am also one of those patients that thought this would help me, any advice would be appreciated. Thank you

[Cindy]

Hi Peggy,

you wrote:

I can feel it and it is bothering me...A local opthamoligist is not crazy about removing it but will do it if I want him to

If it is bothering you and you have a doctor who will take it out, (disclaimer: this is only my opinion, not medical advice) then by all means have it removed. I would get it outta there unless I was offered some really, really, really compelling reason to put up with the discomfort. Better to deal with whatever discomfort there is from having it removed (if any, I don't know as I never had SmartPlugs) then to deal with discomfort from having it in there as a longterm irritant.