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Aqueous Deficiency - as a result of Punctal plugs. help? NGF?

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  • Aqueous Deficiency - as a result of Punctal plugs. help? NGF?

    Hi DEZ community,

    I've been casually reading on this forum posts for a while, but my condition has been getting worse lately. There's barely any tears in my eyes and I have full plugs down and cauterized punctums up so I need thoughts on treating my Aqueous deficiency.

    I was sort of stable until 3 months ago when I visited an "EXPERT" for my MGD who insisted on removing my upper plugs which he claimed were irritating me even though I never complained about them. I resisted yet he still said it's highly encouraged to remove them so i listened to him and my eyes got dry as expected. I went to another doctor to plug them back up, and for some reason the new plugs started scratching my eye. I tried different sizes but they were still scratching and causing a cycle of inflammation. I could feel the tear level going down over the weeks. By the time i decided to cauterize them my aqueous levels had went down significantly and my eyes are very dry and scratchy.

    I tried Prokera for a few days this past week in one eye and I still don't feel any benefit from it. I'm really not sure what to do. I tried albumin drops (similar to autologous serum) my doc recommended would heal the ocular surface but haven't felt much benefit from them. I've tried all the classic approaches and still using Restasis now.

    I believe that I need NGF drops in my eye (which is why i tried prokera to begin with but didn't really benefit from). Any thoughts on how to heal the ocular surface after this damage from plugs? What has worked for you to increase aqueous level?

  • #2
    So sorry that you didn't get a response, just noticed your post! Very sorry to hear your worsening of ADDE. - I'm wondering if you're really and truly fully occluded in the lowers? (You are obviously very experienced with all this, so presumably so, but just wondering.) How are you doing in terms of inflammation now? Do you have a cornea specialist currently? I'm not quite sure what you mean by 'all the classic approaches' but, I'm wondering about other medications including CEQUA? - Also, moisture chamber glasses? Scleral lenses?
    Rebecca Petris
    The Dry Eye Foundation