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Multiple parasol punctal plugs found in my eye

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  • Multiple parasol punctal plugs found in my eye

    I have been wearing punctal plugs for at least a decade. Originally, my plugs lasted many years. But recently they have been frequently falling out (or so I thought) and I needed ever larger plugs because my puncta seemed to be getting larger.

    Yesterday, I visited my ophthalmologist to replace an upper plug that had fallen out. I also had him look at my lower plug because it looked like it was sticking out.

    He told me it was infected and he took it out. Then, to his surprise and mine, he proceeded to remove another 3 plugs from the same puncta.

    It turns out they were not falling out but falling in! These are the umbrella type plugs or parasol plugs.

    So we decided to check the other eye and sure enough there was at least 1 other plug in there too that he thinks he got out but didn't "catch".

    He irrigated (tried to push out with a syringe) from the top puncta while closing the nasolacrimal duct to try to force any lower plugs out. No plugs came out and only very little fluid pushed through.

    He did this on both eyes and I felt the fluid drain into my nose but only on the left side. This makes me feel like maybe there's one in my right upper side. He doesn't think this is likely because gravity would pull the uppers down and out not in. I'm not convinced.

    He did not want to irrigate the bottom for fear of pushing any lodged plugs further down.

    He put me on antibiotic/steroid drop for 2 weeks when I will see him again.

    I am very worried because I know these migrated plugs can cause serious problems and I have no idea if there are more in there and maybe in all 4 puncta since they have all been replaced frequently as of late.

    I am considering cautery but am afraid to block the puncta if there's plugs still in there.

    How can I be sure they're all out?

    I have found a procedures that might be helpful for determining if there's plugs in there and I'd like to know if anyone else had this experience and what was the outcome?

    Here's what I found:


    endoscopic approach

    probing the nasolacrimal duct


    Tear drainage test?

    Imaging with dye

    Any information/experiences with this problem is greatly appreciated.

    Thank you