Update: Tear Duct Plugs

On January 7th, 2019 I had tear duct plugs put in the bottom interior tear ducts of my eye lids.
I'd seen an opthalmologist last summer who told me the bottom plugs help even more than the upper plugs to maintain moisture on the eyes.
So it took 6 months and I finally have these put in.

I did quite well for a long time with just upper plugs.  However, it is probably mainly aging that I'm needing both upper and lower plugs now.
The opthalmologist did a special test where they see if you have medical issues with the lids but that was negative.

This time, I had to have the lower plugs inserted twice.  The first ones fell out a couple weeks ago.
Hopefully this set will stay in.

I still highly recommend others consider this treatment, especially those that suffer from severe cases of dry eyes.

Update - Tear Duct Plugs

I now have just upper tear duct plugs, and they seem pretty sufficient for dry eye remedy.
I keep Systane Balance Eye Drops my opthalmologist told me to get and use them as needed (the purple box).

I believe the lower tear duct plugs were more effective, but for now, I am happy with just the upper plugs.

update - just upper ductal plugs now

Since having both upper and lower tear duct plugs caused me excessive tearing to a severe degree, I made an appointment to return to my opthalmologist.  One bottom one fell out, from my having to wipe my eyes so much because of the tear overflow.
So upon arrival we decided for me to retain the new upper ductal plugs and he removed the remaining lower plug.

One thing he told me I had not known before is to use warm moist compressions morning and night on the eyes and that it -- if done regularly - helps increase tear production so I must try this.

I note that the lower tear duct openings are still slightly enlarged after the plugs now being gone a week, but they should shrink back to normal size openings with time.

In the interim, for now, with just upper ductal plugs, I'm having more dry eye symptoms so will try the eye compresses.  Eventually if this doesn't work out, I'll find out about trying other types of plugs now on the market.  But hopefully this will be good enough to last for quite a while.

Update - having upper and lower tear duct plugs

Unfortunately having both upper and lower tear duct plugs caused my eyes to tear so bad, I was having to wipe my eyes all throughout the day and it was not good.
Then, from wiping them so often, the one lower plug came out.
So now I have 2 uppers and one lower plug.  The right eye has both plugs and is tearing badly.
The left is doing fine with just the upper plug.
I return to the doctor in a couple weeks.  He was going to remove a set but now since the one bottom one came out, I'll ask him if I can just keep the two new upper plugs and that he remove the one bottom plug.

I did some internet research and found this:

Welcome to Dry Eye Talk!

So 4x occlusion is too much and 2x is not enough? Maybe time to investigate different plug brands and designs if you have not already? In particular, perhaps EagleVision's flow controller plugs (which permit more drainage than their standard plugs) in the lowers might make having upper plugs more workable? Mind you I don't have much experience at all with the flow controllers, it just occurs to me as something that "sounds sensible" for this kind of situation.

http://www.dryeyezone.com/talk/showthread.php?1774-Any-advice-re-combination-of-upper-and-lower-punctal-plugs

There are several types of punctal plugs, which have different properties and uses depending on the material from which they are composed. They are commonly divided into punctal (or punctum) plugs, which are placed at the top of the puncta, with the tops visible and intracanalicular plugs, which are inserted into the canaliculus, and thus cannot be seen after insertion and need to be flushed out with irrigation for removal. In practice, both types are plugs are commonly referred to as “punctal plugs”. Collagen implants are dissolvable punctal plugs that may be used as a trial to assess if occlusion will ameliorate the patient’s symptoms and to rule out intolerable epiphora due from occlusion before irreversible punctal occlusion is performed. They dissolve within 4-7 days and do not cause complete canalicular occlusion. They are available in a variety of sizes and from a variety of manufacturers (see below for list of some manufacturers). Collagen implants may be used as a trial of punctal occlusion prior to more permanent treatment, for temporary enhancement of topical medications, for post-operative reduction of dry eyes and in the assessment of the effect of aqueous tear deficiency on ocular surface disease.

Of note, once a plug has been displaced from a punctum, subsequent plugs are more likely to be displaced from that punctum, and overdilation of the punctum should be avoided. There are several risks to the placement of silicone punctal plugs. The plugs can be advanced too deeply, causing inadvertent insertion into the nasolacrimal system, which necessitates surgical removal. Other risks of plug placement include the development of a pyogenic granuloma, canaliculitis, or dacryocystitis, although these are infrequent side effects. More common risks include spontaneous extrusion of the plug (which occurs in almost 40% of patients within the first six months), local irritation at the site of the plug, or epiphora which is intolerable to the patient. Excessive tearing is more common when both the upper and lower punctal are blocked. In cases of intolerable epiphora, the plug can be removed at the slit lamp. There are several companies which manufacture both collagen and silicone punctal plugs, including Eaglevision, US-IOL, FCI Ophthalmics, Delta Life Science, Odyssey, Angiotech, Medenium, Lacrimedics, Oasis and others. While collagen and silicone plugs have been available for some time, newer technologies have developed such as the SmartPLUG (by Medennium), which uses a hydrophobic acrylic polymer and the Oasis Hydrogel Intracanalicular Long-term Plug, which uses a hydrogel material. These materials change shape when exposed to body temperature and tears, respectively, allowing them to reshape into soft, gel-like plugs that occlude the punctum. In addition, silicone plugs have been modified to have varying shapes and sizes, with some designed to regulate the lacrimal drainage for cases in which total occlusion may cause epiphora. The Herrick dissolvable plugs (from Lacrimedics) function as medium-term occlusion treatment, lasting approximately 4-6 months. They have the same indications as collagen implants, but a longer duration of action. They are made of polydiaxonone and are placed in the horizontal canthus similarly to intracanalicular collagen implants.

http://www.eyevertise.com/Content/eye_exam/punctal_plugs/121lasik/punctal_plugs.aspx

If he removes the one lower plug and I do okay with the 2 new upper plugs, then the situation will be resolved. 

I hope that will fix everything and the 2 upper plugs will provide me with enough eye lubricant of tears so I don't have to investigate trying other types of plugs.

Again, all said and done, from my experience, I still highly recommend punctal plugs as a solution for dry eyes.  Not having red eyes, not having physical discomfort from dry eyes, not having to use artificial tears and eye drops constantly is a huge plus.  I use a computer at work and do a lot of reading documents with small print so it is imperative that my eyes are lubricated and maintained so they can perform their best.

On a side note, I turned 58 last month and my annual eye exam showed my vision has not changed for the last 2 years.  I use reading glasses and bifocals at work, and recently got the trifocals for 3 purposes in one pair of glasses:  reading, computer monitor viewing and distance.

Today got Upper Tear Duct Plugs!

Today my optholmogist inserted tear duct plugs in my upper inner tear ducts of my eyes.
He checked the lower tear duct plugs I had inserted several years ago, and they are doing fine.
I asked to have the upper plugs inserted because I've been having to use more eye drops lately and thought I'd see if these additional plugs would help.

He told me the plugs are good until they fall out or get disloged by wiping your eyes.
So now I'm all plugged!

Note: He added a drop of numbing stuff in the eyes, then used a little instrument to dilate the ducts, then inserted the plugs.  The procedure was painless and took only about 15 minutes total.

Also before that had regular annual eye exam so had drops to dilate my pupils. Vision was unchanged for last 2 annual exams! And I turned 58 other day.

Driving home with dark sunglasses helped keep the blinding snow from bothering my eyes.  As I approached my home town, a fog enveloped the area and hoar frost from this morning was still on all the trees, bushes and grass -- quite beautiful.

My eyes are tearing more than normal right now.  As I recall, for the first set of lower plugs it took about 2 days before I didn't notice them. 

Right now I'm just noticing more moisture/tearing on my eyes.

So for those who try the lower plugs and after a year or two experiencing recurrent dry eyes, I suggest you try getting the upper duct plugs too.

I have had the plugs now for one year!

Happy update:  One year has passed as of yesterday since I had the ductal plugs inserted into my lower inner tear ducts below my eyes, and I must say I am still extremely satisfied and happy that I had them inserted. I am careful not to rub my eyes, as that could dislodge them. 

I have experienced no pain or irritation from them.

I do not even feel they are there.

They are barely visible to the naked eye, and one must roll the eyelid down to view them.

The color blends in with the skin.

I am happy to say these ductal plugs have saved me money.  I hardly ever have to buy moisturizing eye drops my doctor recommended.

My eyes hardly ever look red, are rarely irritated and I use eye drops maybe once or twice a week now!
And I was using them 4, 5, 6 or more times a day before I had the ductal plugs inserted.

The person who invented these is a genius.
He should receive honors and awards for this invention.

For anyone suffering from dry eyes, dry eye syndrome -- please consider getting these!

You won't regret it!

:)

Update re: Tear Duct Plugs

October 19th, 2013:  This is an update.  Just to let you know the tear duct plugs are totally still working and have alleviated all dry eye symptoms I experienced in the past.  I have never experienced any side effects or problems from them since I had them inserted. 

I do not miss having to put eye lubricant drops in my eyes.  I still keep some Systane Balance artificial tears / drops my opthalmologist told me to get, and only have to use them once in a while.  Not even every day!!  My eyes hardly ever appear reddened, in contrast to how horridly red / bloodshot they appeared before I had the plugs inserted. 

You cannot see the tear duct plugs, unless I use a higher powered mirror and manually pull down my lower eyelid -- then you can see a tiny spot which is the top of the ductal plug, covering the tear duct.  They have never dislodged.  I take care to avoid rubbing my eyes.  I am able to shower and swim and do all the things that I did before getting them inserted.

I am saving money by not having to always buy artificial tears, etc.

Whoever invented these, they are a godsend to humanity.
Sometimes they are referred to as punctal plugs.

I see that Eagle Vision invented the world's first Punctum Plug in 1974.

Links - Punctal Plugs

Came across a link to several articles at wisegeek.com about Punctal Plugs (Tear Duct Plugs):

what are punctal plugs

Also on wisegeek.com, there is an article about the Schirmer Test - a test that helps doctors diagnose various medical conditions that cause dry eyes:

what is the schirmer test

The website DryEyeSyndrome.com has excellent resources, which includes explaining the various types of plugs:

encyclopedia plugs

DryEyeSyndrome.com also has excellent forums for those suffering from dry eyes and those who want to discuss the plugs:

forum PLUGS-etc

They're still working!

I'm happy to report that the ductal plugs I had inserted into my inner lower tearducts to help combat dry eye syndrome/red eyes are still working!!!!

I am still using Systane Balance lubricant eye drops which my eye doctor recommended, and find them superior to all artificial tears and eye drops I have ever used.  I just hope they remain on the market!!! When you find products that truly work extremely well, you sure don't want them to go away.

If anyone out there is seeking a solution to dry eye syndrome, these two products are the answer and remedy.

I am truly amazed and highly pleased with how they  have resolved my dry eye syndrome problem.

Still Working!

Today is June 10th, 2012 and I am most happy to report that the tearduct plugs are STILL WORKING!!!

I never notice they are there, and my eye redness / dry eye problem is no longer an issue in my life.

It is a relief to have a physical problem completely resolved!

These were my eyes in my early 40s - a decade ago.
I note the whites were whiter, didn't  have the Dry Eye Syndrome yet.

Turned age 55 in December, what a difference a decade makes.

Below is a photo of my eyes now.

Update - How the Ductal Plugs in my Tear Ducts are Doing

Tomorrow is Friday, and I've now had the tear duct plugs in my tear ducts since my visit to the eye doctor Monday -- 3 1/2 days.

I have not noticed much improvement yet as to having wetter eyes.
They are still getting red by noon or so, and I'm still having to apply the eye drops (Systane Balance Restorative Formula made by Alcon -- an over - the - counter eye drop).  I'm applying them at least 6-8 times a day still, two drops in each eye.

One woman at work told me she knew a woman that tried them and they didn't help at all (real encouraging!).

Well if having two tear ducts plugged doesn't do the trick, I can have two more of the tear ducts plugged (in the upper eyelids), which would HAVE to help!

Today I was filing and it is a dusty room and that probably didn't help.

One thing I am going to continue to do is eye exercises, just when I'm lying down to go to sleep.  I've done them for years and I do believe they helped delay my need for reading glasses.  I didn't start wearing reading glasses until my early 40s, and even now I only need 150s - 175s to see to read.

I am optimistic about the ductal plugs, and hope they will help the Dry Eye Syndrome I have.  I plan to get outdoors this weekend, even though its winter and to be rather cold, but need the sunlight and fresh air.

These are the eyes I'm trying to heal.
I'll post again in one more week to update my progress.

Dry Eye Syndrome ("Keratoconjunctivitis sicca")

Today at age 55 I had tear duct plugs inserted by my eye doctor into the two tear ducts located at the inner corner of the lower lids of both eyes.


The procedure was completely painless & took about four minutes per eye to insert them, if that.  The doctor was going to numb the duct areas with a topical anesthetic but I asked her not to, as I didn't think I'd have a problem without it.  Sure enough, it was just a few moments of sensing a slight prodding with a tiny instrument into the tear ducts, she shot & released the little plugs into the ducts, & presto!  It was done.  So I would encourage others to try to have it done without an anesthetic.  If I had gotten it, it would have worn off quickly, but I really didn't want to tolerate an hour or so of having the sensation of numb lower eyelids!


This blog is to document my experience with tear duct plugs & hope it can benefit others who may not be aware of this remedy for Dry Eye Syndrome, or may help others consider getting tear duct plugs for themselves.


Punctal Occlusion (tear drainage duct occlusion) is a procedure that eye doctors use to improve the symptoms of Dry Eye Syndrome (inserting punctal plugs (silicone or collagen) into the tear drainage area of the eye to keep the tears in the eyes longer.  I had silicone plugs inserted today.

Dry Eye Syndrome ("Keratoconjunctivitis sicca")


This is a medical condition where the eye surface & tear-producing glands (lacrimal glands) are chronically inflamed due to insufficient tear production.  It is a complex condition & can also cause neurotrophic deficiency & meibomian gland dysfunction.


As people age, from age 40 & older, develop this condition which is quite common. In fact, after age 59, prelevence of this condition more than doubles!


Those age 89 & older -- both sexes experience Dry Eye Syndrome more  than any other age.


It can also occur when one uses the computer a lot or does a lot of reading. Some medical conditions, certain medications & environmental factors can cause Dry Eye Syndrome. 


As many as 40 million people in America suffer from this condition.   Postmenopausal women may be the most susceptible due to decreases in hormone levels that can lead to loss of antiinflammatory protection and decreased lacrimal function.


People with other inflammatory conditions -- particularly allergies, asthma, & collagen vascular disease are also at risk.


People who've had eye surgery can have it.


Those who suffer with Dry Eye Syndrome are at risk to develop infections that could blind you -- such as bacterial keratitis, & these patients have higher risks when they undergo procedures, such as LASIK.


Bacterial keratitis is costly & can lead to corneal transplants — a $20,000 procedure!!  Indirect costs of this bacterial condition can result in permanent scarring.  Without a corneal transplant, these patients can experience impairment in driving at night, engaging in certain activities and it can affect their work performance. It can affect the quality of one's life! 


Dry Eye Syndrome can also indicate other health conditions. The doctor should should always refer a patient with Dry Eye Syndrome to an ophthalmologist.


When inside an airplane, living in a dry climate, being enclosed in heated or air conditioned rooms, these situations can cause some patients (ike me!) must apply artificial tears several times every hour, with little lasting relief exacerbated by protracted blurred vision.


Those at Highest Risk for developing Dry Eye Syndrome include those with the following conditions:


• Inflammatory diseases (vascular, allergy, asthma)
• Autoimmune diseases (RA, lupus, colitis)
• Peri- and post- menopausal women and Hormone Replacement Therapy patients
• Diabetes mellitus
• Thyroid disease
• Sjögren’s syndrome
• Corneal transplants
• Previous keratitis or corneal scarring
• Extracapsular or intracapsular large-incision cataract surgery
• Laser in situ keratomileusis (LASIK)
• Systemic medications (diuretics, antihistamines, psychotropics, cholesterol-lowering drugs
• Contact lens wear
• Environmental conditions (allergens, cigarette smoke, wind,dry climate, air travel, chemicals, some perfumes)


Caffeine was surprisingly found to have a protective effect in a research study (didn't help me, though!).


Here is a great paper on Dry Eye Syndrome:


http://www.ptcommunity.com/ptdigest/0312_ptd_dryeye/0312.ptd_dryeye_mc.pdf


Dry Eye Syndrome affects worker productivity.  Personally I find this to be true, when I have to stop every hour or more to insert artificial tears or eye drops into my eyes, & it makes for reading small print & reading print on a computer monitor more difficult as I get blurred vision, eye fatigue, etc. 


It also affects one's appearance.  By mid-morning, my eyes appear bloodshot which makes you look tired, & people think you aren't getting enough sleep.  By the end of the day, my eyes are completely shot & I look like someone that was an actor in a Zombie movie!!!

Treatments for Dry Eye Syndrome


First my eye doctor had me using artificial tears & after about 8 months, it wasn't helping & I was using it more and more - 6 - 10 times a day or more!
Then my eye doctor had me purchase a new over-the-counter eyedrop for dry eyes -- "Systane Balance" the "Restorative Formula" brand.  These are lubricant eyedrops of clinical strength & provide intensive therapy for dry eyes, and are made by Alcon.  I purchased a 1/3 ounce bottle.  The active ingredient is Propylene Glycol, which is a lubricant. 


These eyedrops are fantastic, & help a lot better than the artificial tears.  I have a friend my age who also suffers from Dry Eye Syndrome, & her doctor first prescribed these same eyedrops & they have solved her problem. 


Unfortunately, using them was not enough.  I was still needing something more.


Research has determined that Dry Eye Syndrome is a systemic disease &
that it responds well to cyclosporine anti-inflammatory therapy. 


Rather than get an expensive prescription for Restasis, a new prescription that treats Dry Eye Syndrome (and has some possible side effects), the tear duct plugs were cheaper & are a drug-free solution to this condition.


I will post in this blog in the future - a week, two weeks, a month, etc. to report to my readers progress I experience with the tear duct plugs.




Acupuncture


One study was done in December, 2010 where they found after treating patients four times a week with acupuncture, that it effectively relieved the symptoms of dry eye & increased watery secretion in the eyes.


I would think it would be inconvenient & expensive to have to get four acupuncture treatments a week to get results, & don't know if it would provide long or short term relief.


Symptoms


Dry Eye Syndrome gives one a feeling of discomfort in one's eyes which generally worsens as the day progresses.  You might have a sensation of burning, itching, feeling your eyes are gritty, irritated, have blurring of vision, red eyes, or other ocular symptoms.


You must treat Dry Eye Syndrome because it won't just go away by itself.

How Tear Duct Plugs Work


The human tear film consists of 3 layers:  lipid, aqueous, & mucous -- which are produced from different parts of the eye.


The aqueous layer is produced by the glands of Krause & Wolfring & by the lacrimal gland, all located in the superior eyelids. The lipid layer located is located farthest from the eye & is produced by the meibomian glands. It functions to slow the evaporation of the underlying tear layers. The mucin layer of the tears located directly on the cornea is produced by the goblet cells of the conjunctiva.


The tears coat & lubricate the eyes & then exit through the eye’s drainage system.  The tears flow into the drainage holes, called lacrimal punctum, which are located in the inner corners of both the superior & inferior eyelids. From the punctum the tears flow through to the drainage tubes, called the canalicula & then to the lacrimal sac & then the nasolacrimal duct, & finally exit into the nose & to the back of the throat.  (Thats why your nose runs when you cry!)

The goal of insertion of tear duct plugs is to slow the drainage of tears to keep the tears on the eyes longer, for added lubrication.  Punctal plugs are very small biocompatible devices that are inserted into the lacrimal punctum.  Punctal plugs are very small usually ranging from 0.3 mm to 0.7 mm in diameter. They are made up of two types of materials, collagen & silicone.  The collagen plugs are dissolvable so they are temporary, lasting from a few days to a few months.  These are usually used first to determine if punctal occlusion would be beneficial for the patient or for temporary dry eye problems such as that caused by LASIK surgery.  Silicone punctal plugs are used for more permanent, longer lasting occlusion.


For more information about the plugs and other eye conditions, visit this website:


http://www.mastereyeassociates.com/eye-diseases-treatments/punctal-occlusion