Punctual plugs: how to find the best fit?

[hopeful_hiker]

I recently got lower punctual plugs. One eye was great from the beginning with a Parasol plug. I had to swap the second plug for a cylinder one because my puncta in the left eye is facing the eye. It does not work as well and I am paranoid it will migrate somewhere.

I would rather have a “mushroom” cap style plug in both eyes. Do you know any good brands for puncta that is more in direct contact in the eye? How can I try different ones without shelling hundreds of dollars? I am happy with my right plug.

Also, is cautery always hard to reverse?

I only get epithora from yawning.

[PRK]

"“I had to swap the second plug for a cylinder one because my puncta in the left eye is facing the eye.”"

Every plug I had the was too scratchy and rubbed against my eye fell out eventually because the plug was too big for my tear duct size. When I went a size down they were much more comfortable and stayed in longer. (Going on 7 years now.) The cap of the plug should sit very slightly below the surface of the tear duct. Your tear duct is shaped like a crater and the plug should sit a little below the rim of the crater so it isn't contacting your eye.

"“Also, is cautery always hard to reverse?”"

It depends on what you mean by reverse. From most of the posts I’ve read it seems like the tear ducts can have a tendency to open back up again and can need to be cauterized multiple times. Several members recommended having the the tear ducts sutured and cauterized at the same time to prevent reopening. Also from what I understand once cauterized you won’t be able to use punctal plugs again. They are basically trying to scar the punctum shut.

[hopeful_hiker]

Thank you for the detailed response!

[SirDryEye]

A doctor is going to be putting in mine next week, do I have to tell him what plug I want or something? I’m so confused... how does he even know the plug that right for my eye he hasn’t even measured it yet?

[MGD1701]

hi SirDryEye
Good question. Just ask dr if you have inflammation issue, if you have, normally plugs are not a good idea as it will make inflammation worse.

[Hokucat]

SirDryEye, Typically eye doctors who regularly put in plugs have on hand different styles and sizes. They will look at the size of your duct and try the size that looks appropriate. It might take a couple of tries to find the right size. But it should be a very quick and painless procedure. Are you getting lowers only first? If lowers alone don’t help enough, you might also try getting the uppers plugged too.

Regarding the different types of plugs, the umbrella style is the more typical. That’s what I have. From a recent thread in this forum, the SmartPlug style can have a lot of complications, so you might request SmartPlugs not be used on you:

http://forum.dryeyezone.com/forum/dr...-punctual-plug

Also, there are temporary dissolvable plugs that are ideal if you just want to see if plugs help you, before deciding to get the more permanent silicone plugs. But know that the silicone plugs are not really permanent, they can be easily removed. Here’s an article with some info on plugs in general:

https://www.eyevertise.com/content/e...tal_plugs.aspx

[SirDryEye]

hi SirDryEye
Good question. Just ask dr if you have inflammation issue, if you have, normally plugs are not a good idea as it will make inflammation worse.

Surely I shouldn’t have to ask the doctor this and he could be offended as he’s a London consultant who’s been practising for over 20 years.


Hokucat
Im having temporary plugs but in so do I still have to specify about the umbrella plugs. If I ask him not to put in SmartPlugs will he get angry?

[Hokucat]

SirDryEye ,I don’t know your doctor, but most doctors if you give them a logical reason why you don’t feel comfortable with something will comply. For example, there was a certain eye drop with the preservative BAK that my retina doctor thought was the best drop to treat another eye condition I have, but I told him I’ve read a lot of research on the dangers of BAK and personally don’t feel comfortable using it, and would like preservative-free drops. So he prescribed different drops that were preservative-free.

I don’t know enough about different types of temporary plugs. You’ll have to ask if he has different types of these as well.