6 years after PRK dry eye mostly gone with two punctal plugs

[PRK]

It’s been almost 6 years since I had PRK and my eyes are feeling good. I used to have four punctal plugs but two of them fell out probably 4-5 years ago and I waited to see if I could get by without them. So now I just have two plugs, one in each eye. I have a .5mm Eaglevison Superflex plug in the lower tear duct of my left eye and a .6mm Superflex plug in my upper right eye. I don’t really notice them and they have never really given me any trouble. My eyes are pretty normal nowadays and I haven’t really had any major problems for years. My eyes still get a little dry when I’m sleeping but most nights it’s not really noticeable. Every 2-4 months I do get a night where my eyelids stick to my eyes a little and that can cause some pain for a few minutes sometimes but then my eyes start to water and it goes away. They can still get a little dry if I’m doing dusty yard work or stay up really late. I don’t have drippy eyes like I did with four plugs but that wasn’t all that bad anyways. I haven’t used drops of any kind for years. If my eyes get a little dry I just close my eyes and while they are closed I squeeze my eyes shut a few times like I’m yawning to get my lacrimal glands to release some tears. Also if I pretend to yawn a few times I can usually encourage a real yawn which makes my eyes water. Anyways that’s pretty much all I have for an update. Hope everyone is doing well.

Here are a few links to my previous posts if you are looking for more background story.

http://www.dryeyezone.com/talk/forum...ctal-plug-tips

http://www.dryeyezone.com/talk/forum...f-punctal-plug

http://www.dryeyezone.com/talk/forum...y-studies-link

http://www.dryeyezone.com/talk/forum...months-post-op

http://www.dryeyezone.com/talk/forum...k-eye-speculum

[PRK]

Anyone else out there who has seen improvement with plugs or punctal cautery?

[mestizo]

Thanks for posting this, it has given me the motivation to insist on at least trying plugs with my OD. Fingers crossed I notice some improvement

[PRK]

Sure thing Mestizo, hope you are able to find some relief.

[Mask2323]

PRK I also had PRK (2 years ago). I suffered from slight dry eye after wearing contacts for years, but never had significant functional problems. After PRK though, the dry eye got so bad that I can't and still don't sleep without applying Systane gel every night. I got punctal plugs 3 months ago and I'm waiting to see if they improve the situation.

At what point did you start to experience noticeable relief? Do you think it's attributed to the passage of time or to the punctal plugs or something else entirely?

[PRK]

Hi Mask2323, sorry for the late reply. I’m assuming you got silicon plugs? I didn’t see any improvement from temporary plugs at all. When I had 2 silicon plugs placed in my lower tear ducts I saw a little improvement but not much. It was only when I had all 4 tear ducts plugged (the uppers and the lowers) that I had significant relief. I was able to tell the difference as soon as I left the doctor’s office. I also feel that having “wetter” eyes is a better, more natural state for the nerves to heal verse a dry eye. Therefore I attribute my eyes healing to the punctal plugs.

[Guest]

Hi Mask2323, sorry for the late reply. I’m assuming you got silicon plugs? I didn’t see any improvement from temporary plugs at all. When I had 2 silicon plugs placed in my lower tear ducts I saw a little improvement but not much. It was only when I had all 4 tear ducts plugged (the uppers and the lowers) that I had significant relief. I was able to tell the difference as soon as I left the doctor’s office. I also feel that having “wetter” eyes is a better, more natural state for the nerves to heal verse a dry eye. Therefore I attribute my eyes healing to the punctal plugs.

Do you have MGD as well? If so, did the plugs effect your lids?

[PRK]

As fair as I know I don’t have MGD. I have always been pretty nearsighted and can actually see the oil is clear/free flowing when I express my glands. I did a little research on plugs and MGD. Seems like they shouldn’t effect the glands but it is better to get the glands working better and reduce any eye inflammation before getting plugs. You’ll have to try to determine if you feel like you have reduced tear production or not. I would also recommend Theratears for drops if you can find them since they have the lowest osmolarity which should help with inflammation.

Osmolarity
http://www.mastereyeassociates.com/t...cant-eye-drops



https://www.reviewofoptometry.com/ar...ime-of-dry-eye
"Punctal plugs. In patients with MGD or blepharitis, don’t insert plugs until after anti-inflammatory treatment. Otherwise, the plugs will retain the abnormal tears that have high concentrations of pro-inflammatory cytokines
. There are many treatment options for Chronic Dry Eye, and depending on the cause of your Dry Eye, the treatment or combination of treatments prescribed can vary by patient. The majority of Dry Eye sufferers have Meibomian Gland Dysfunction (MGD); thus, treatment of MGD should focus on and include clearing blockages in the Meibomian glands.
Less commonly, Dry Eye can be caused by reduced tear production. This affects a smaller proportion of the population; however, some patients may have both MGD and reduced tear production. Treatment for reduced tear production may require the use of a prescription medication in the form of an eye drop, tear replacements, punctal plugs are other therapy."


http://www.ophthalmologytimes.com/mo...-eye-therapies
“Punctal plugs help retain tears on the ocular surface to help alleviate dry eye disease,” he said. “However, the study cohort varied in their chronicity and severity of dry eye disease in addition to difference in the therapies used. As a result, the change in different dry eye signs and symptoms is expected to be different across the study subjects.” Tear osmolarity may be a leading indicator of therapy efficacy in DED with punctal plug insertion. Thirteen of the 28 patients had reduced osmolarity over 10 mOsm/L. Only eight of the total 56 eyes had a reduction in staining. The changes in the symptoms score were similar between the treatment and sham groups. There were no significant changes in meibomian gland function or lid grading."

http://www.optometrytimes.com/modern...-punctal-plugs
"For patients who are meibomian gland dysfunctional, plugs are particularly beneficial; however, it is important to first address any underlying clinical concerns first. LipiFlow (TearScience) is useful in diagnosing clogged glands, and we can then try to rehabilitate those glands. Once flow is improved, plugs are a suitable option. As a first-line treatment, I would plug patients who are solely aqueous deficient or who suffer from superior limbic keratoconjunctivitis (SLK), auto immune diseases, anatomy problems, and filamentary keratitis."

[Guest]

Hi there PRK Dry Eye Patiet, I was trying to access the links to your previous posts but it says they could not be found. I am struggling mentally, emotionally, physically with my dry eye shortly after my PRK surgery. It has only be 3 weeks but my eyes get so dry and painful that all I want to do is close them. I was hoping I could hear more of your experience so I can gain some hope and relief.