Just a good interesting article.

[SusieD]

This is just a general overview of dry eye disease; causes, assessments and treatments etc but it does throw up some interesting things,

For example, regarding meibomian glands - according to this the lower gland should contain between 30/40 glands and the upper 20/25 - I thought it was about 30 overall. It also mentions that at any one time 45% of glands should be functioning in a healthy eye. Again I would have thought all of them would need to be functioning at their best.

It also mentions a study that calls into question punctal occlusion although it doesnt give a link. Plugs were placed in the eyes of 'normal' patients and although an increased tear volume was noticed initially, this decreased back to prior levels soon after. However I would guess if your eyes are healthy and have enough tear fluid, creating more would just cause the remaining puncta to drain more to create a balance again. Who knows.

http://www.revoptom.com/index.asp?Ar...on_dryeyes.htm

[AccutaneJay]

Plugs

Crap. I have plugs and sometimes wonder whether I'm doing more harm than good. I've read that plugs may not be the greatest because they keep "junk" in the tears and in the eye longer than it should be. By junk I mean, stuff that could possibly be detrimental to the health of the ocular surface.

I still get burning and irritation. I'm thinking about having them removed. Any thoughts from anyone? I thought I noticed initial improvement, but I really don't think they are doing much good. I've had them in since April, and am sort of worried they may eventually may cause scarring of my puncta and I won't be able to reverse it.

[Rebecca Petris]

I think there is an awful lot more medical literature attesting to the benefits of plugs than to the "cesspool" theory of plugs. They need a lot more scientific evidence, IMHO, before I start believing that punctal occlusion is a bad idea for aqueous deficient patients.

[AccutaneJay]

Thanks

Thanks for your feedback Rebecca. I think my doctor said I am only slightly aqueous deficient. Most of my problem comes from MGD (Accutane and previous contact lens wear causing dessication). Are plugs a good idea for people who are mostly MGD and don't really struggle primarily with aqueous deficincy?

[YGB]

My opinion on plugs is that they are overused by MD's for certain dry eye conditions simply because it is one of the few tools in the MD toolbox that they can actually use to try to "help".

I agree with Rebecca that I can see plugs helping for aqueous deficiency if that is the primary or sole problem, but if there is MGD with inflammation associated with it, I have been told by two respected MD's that keeping the inflammatory agents trapped in the eye will only add to the inflammation. From a purely non-scientific opinion, if there is inflammation in the eye caused by bad tears or inflammatory agents in the tear film, then plugging up all 4 puncta and eliminating "natural" drainage is likely not a good thing. Perhaps a compromise in this case if plugs might help is going with 2.

When I had 4 plugs put in, they helped for a few days and then the tear volume dissipated after a few days of being plugged to what seemed to be its pre-plug dry state. Then my inflammation and redness in my right eye got worse.

In the absence of science (and there is so little good scientific evidence when it comes to dry eyes), it is my opinion that when I got 4 plugs put in, my eyes felt wet for a few days and then reverted back to their pre-plug dry eye state. Why did it happen? I don't know, but I know that it wasn't my imagination.

Having said this, when I had 2 plugs removed and 1 subsequently fell out, my eyes felt dryer for about a week and then adjusted back to feeling "normally" dry. My MGD inflammation has also improved since removing the 2 plugs as has the redness in my right eye. This is just my experience and I should note that I am 5 months post-LASIK so obviously there are different variables for different people.

Just my thoughts that seems supported by a few MD's and studies. However, ultimately, with dry eye it seems like what works for one person doesn't necessarily work for another. Good luck!