Can't keep Punctal Plugs inserted!

[Rick0517]

I have been receiving Punctal Plugs since about April and they never seem to last more than a few days before either washing out or or my eyes being so dry that they are expelled. Frequently this happens when I wake up or after applying my Glaucoma medications which burn and cause my eyes to tear alot. I would appreciate any advice that anyone might have as my insurance will only cover just so many replacements and I'm tired of running back to my Eye Doctor so often.

[redhector]

Drh

If you feel the plugs were successful, your puncta can be surgically closed, elliminatingt he need for plugs. BUT, glaucoma medications have been known to cause blepharitis and puntal plugs are not recommended if you have blepharitis. So you need to know the cause of your dry eye before continuing with plug therapy.

[jadavispcfl]

If plugs don't work, then your doctor may cauterize your duct

My old doctors put plugs in that came out. My new doctor recommends cauterizing the duct. It could be reversed, if needed. You may want to ask your doctor about this.

[PotatoCakes]

I'm fairly certain cauterization cannot be reversed. The ducts are being burned shut, causing scar tissue to form.

I recently saw a physician who told me many dry eye patients have been found to rub their eyes during their sleep if they have punctal plugs. It's one of the ways the body encourages them to come out. Since you mention it's worse in the morning, do you use a mask or anything else when you sleep? If not, you might try a sleep mask in case you are rubbing your eyes during your sleep. A mask may not prevent you from rubbing your eyes if you do it but it's worth a shot.

[jadavispcfl]

My doctor, Dr. Steven ******, wrote the book, "Reversing Dry Eye Syndrome". He states in the book that cauterization could be reversed, if it is a light burn. I'm no expert, and I'm sure others have different opinions on this topic. I just want to clarify where I got that information.

[djb]

Had the same problem....went to cautery!

[monamour]

cautery

I just had my cauterization reversed last week after many years of lowers being cauterized and causing extra tearing. I have a stent in for a few weeks until healing is complete.Doctor said left one was fairly easy to open, but right one was cauterized further and was harder to do, but did manage to open it. So, therefore, it can sometimes be reversed, depending on how aggressive doctor was with cauterization, but it does require going through a surgery to achieve it...

[Irina2]

Dear Rick0517,

Thermal or laser cauterization (permanent closure) is an option to punctal plug insertion (temporary closure) of puncti. First, there are a number of designs or brands of punctal plugs that can be fitted specifically for you, e.g. parasol from Odissey, Sharpoint UltraPlug, TearSaver from CIBA, FlexPlug by Eagle Vision, Herrick Intracanalicular lacrimal plug by Lacrimedics. Have your doctor examine you carefully and elicit history of the mechanism by which plugs might fall out in order to find the best fit for you. Secondly, permanent occlusion is an option - make sure you have low numbers on Schirmer's test or otherwise you may have excess tearing and would need surgical reversal of your closure which sometimes can take a minute and sometimes requires an extensive procedure to create a new passage for tear outflow. You may consider permanent closure of only upper puncti. The most helpful is in-depth discussion with your ophthalmologist to make sure your condition and situation are properly addressed.

Hope it helps!
Sincerely, Irina Ganelis, M.D.

http://losangeleseyeinstitute.com