Punctual plugs

[sychen]

Dear Dr. Hagan,

I am 26 year old, and I have been suffering from dry eye problem for 8 years. I plan to have a temporary punctual plug inserted into my left eye as a trial to see if it works.
My questions are :
1) for a temporary plug, if I have a choice, what type/material of plug do you recommend/use in your practice?
2) if the temporary one works, I will use a permanent one. What type/material of plug do you usually use in your practice?
3) What are the risks you have observed with the plugs in your clinical experience?
4) Are the plugs typically successful for your patients?

[John C Hagan III, MD, FACS, FAAO]

It is not the brand that is important it is the shape/type. We several brands.  The Smartplug in my opinion is absolutely the worse and should be avoided.   Be sure you're seeing an Eye MD ophthalmologist. Tell him/her you don't want a smartplug or any plug that does not have a top that is above the lid that can be removed easily.  Know this in the last year I have not put in more than one or two sets of plugs. With drops/gels/ointments/lacriserts/and especially restasis (which my wife has been on for 4 years) I almost never need the plugs.  (fish oil helps also)
JCH MD

[sychen]

Thank you, Doctor. I am sorry to bother you, but once you know the brand, could you let me know, so I can tell my doctor to consider? Thanks.

[John C Hagan III, MD, FACS, FAAO]

No I do not use smart plugs; they are "buried" and hard to remove. i've seen several patients with problems that have required surgery to fix and get them out.     I do not know the brand but it's a plug that has a tab that holds it on the surface and is quickly and easily removed but stays in the right place just fine for most people   We never ever use smartplugs in our practice.

JCH MD

[sychen]

For the permanent, easy to remove plug, is it the same as  smart plugs? There are several types of permanent plugs. Which one do you usually use? Thank you.

[John C Hagan III, MD, FACS, FAAO]

1. I do not use temporary plugs I don't think they are useful at all. I think its also very important to avoid plugs that are below the surface and hard to remove. I just insert a permanent, easy to remove plug.
2. The plug sometimes comes out and needs to be put back in.
3. No read my article on dry eyes on the eye forum front page. I use punctal plugs last. My scheme:  drops-gels-ointments-Omega 3 fish oil-  then jump to Restasis and/or Lacriserts then plugs last.

JCH MD