dry eyes, punctal plugs etc.....

[ptmitchel]

I've had the punctal plugs for a couple of years. I am using allrex 4X a day and Soothe. I also recently got computer glasses to relieve the eyestrain.  (I still have eyes that run which has to be explained a lot at work that I'm not crying. Too much information to have to provide to co-workers throughout the building who now realize I'm just getting older, though don't particularly look it.) My left eye runs so much that I get irritated skin around that eye and eye makeup tends to run off which also isn't good in a appearance conscious workplace. My vision is impaired when my eyes are running. The right eye also has a punctal plug but doesn't run too badly and is tolerable.

Other health conditions -- seasonal allergies, low level treated depression & low thyroid. Any ideas? Is there anything nutritionally I can do? My optometrist has had me on fish oil and I eat wild salmon at least every other week.

I'm frustrated. Aany ideas?

[Bobed]

Is there any association with dry eyes and atypical facial pain/headaches?

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

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[ace399]

Plugs are in my bottom ducts.  No problem.

[NeDC]

Hi,

I just went to the eye doctor yesterday and  he recommended me for the punctual plugs and thinks I will truly benefit from it.  The past 2 years my eyes have been really bothering me.  I get more redness then usual and I cannot wear my contacts all day like I used to.  Granted, I am at a computer all day but I've had contacts for 5 years before this and they have never bothered me so much.  My eye doc did the dry eye test and my tear duct evaporates in 3 secs, well below normal.  I have never taken a medicine or prescription eye drop for dry eyes but he wants me to go to straight to the plugs.  I wanted to see if this is a good idea for me and if I should do it.  I thought about going to drops but I know this is very expensive and my insurance covers 100% for the plugs.  I want to see if anyone has gotten it done and I just want to know the negative and positive things with them to decide if I should get them.

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

Yes they can. Call your eye MD tomorrow and go in to let him/her look at them.
JCH MD

[nurse28]

Can punctal plugs scratch your eyes? I got them today and my left eye is really scratchy in the corner where the plug is.

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

You can google the term and go on the manufactuer website.

There's really nothing at all complicated. We just tell patients to avoid rubbing they eyes and be very careful with washclothes at the inner eye. That's about it.

JCH IIIMD

[KarenO155]

Where can i find patient education regarding the after care involved with Punctal Plug placement?

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

Forget what the optometrist said. The optometrist is not a physician and, in my opinion, frequenty are over their heads treating most types of medical disease.

I would see an eye MD.  Unless you have an indwelling plug---I hope not they are hard to remove and I never use them----the extermal plug is very easy to remove and reinsert.

Good luck. Let me know down the road how things turned out and if taking the plugs out helped.

JCH III MD

[ptmitchel]

Thank you so much. I'm so pleased I found you and this site yesterday. Yes, the tears run down my face multiple times a day especially on the left eye and most of the time if feels wet so my vision is blurred. My eyes have never been totally dry so the diagnosis of "dry eyes" astonished me. Last year my regular physician suggested removing the plug but when I asked the optometrist about removing the left one he didn't think that would be a good idea and wanted to try allrex instead.  

I tried Restasis a few years ago and like many gave up too quickly. I'll be back at the optometrist next week to give it another try.  I If that doesn't work, I'll ask for a referral to an opthamologist. I have a physical coming up so will also get evaluated for Sjorgren's as I do have joint pains I thought was arthritis. Thank you for your comprehensive and excellent guidance. I will definitely pursue this direction.

[John C Hagan]

First if you are getting "overflow" where your tears actually run down your cheeks then you should probably consider having the plugs removed. "Dry Eyes" is a poor term for the problem and there is a movement to call it "Dysfunctional Tear Syndrome" where on the one end is a eye with no moisture at all, absolutely bone dry. Tear duct plugs work best with this type of problem. At the other end is the eye that runs water all the time. the problem is the tears are of a poor QUALITY so the eye dumps out a high QUANTITY of poor quality tears that are too much like water and not enough like oil. The tear duct plugs often make this much worse.

Alrex 4 times per day is a lot of steroid, granted that Alrex is a 'weak' steroid.

I would strongly suggest you see an ophthalmologist Eye MD physician, if one is available one that specializes in corneal and external disease.

My two suggestions would be to remove the tear ducts and a trial of restasis of AT LEAST 10 WEEKS. With restasis the onset of action is very slow and benefits may continue to acrue up to six months. If helpful you are much safer on chronic restasis than chronic steroids.

Also read the post from a previous response below my initials.

JCH III MD

a Schirmer test of zero indicates that you have severe dry eyes. I'm assuming from your posting that you have tried both preserved and unpreserved artifical tears, gels or lubricating ointments at bedtime, environmental modification, etc. Don't discount eye drops. There are over a 100 different brands of artificial tears and they can't all be lumped together. Sometimes one will find the perfect drop. Because the problem is so prevalent the pharmaceutical compies are coming out with new products all the time. Some of the newest are Systane preserved and unpreserved drops and Optive drops.

If you took Restasis you have used the best prescription medication. A "trial" of Restasis is a minimum of 8 weeks of therapy using one drop in each eye twice/day. Because of the way Restasis works, it takes two months to "start working". I have found that many patients use it for a few weeks then conclude it won't help. The medication often stings when therapy is begun--it usually gets better by week three or your Ophthalmologist (EyeMD) can prescribe a mild steroid drop for a couple of weeks. If you did not take for 8 weeks you need to restart therapy. Improvement often continues for up to 6 months.

If you have tried tear duct plugs you should have had all for tear duct openings (puncta) plugged with a permanent plus (not a disolving one). Usually just the lower lids are done with mild dry eyes. If your problem is as bad as you say, you and your ophthalmologist should discuss permanent closure of some or all four of the tear duct openings with cautery.

Additional things that can help include a diet rich in fatty fish (eg salmon, sardines, etc). Fish oil taken by mouth usually 2 to 4/day has been show to help some patients. In addition there are non-prescription pills for dry eyes available at most major drug stores or by direct order from the companies. Thera-tears formula for dry eyes is probably the most widely used. You can use any search engine to pull up the websites of the companies that see these.

In dry eyes associated with corneal damage, moisture retaining goggles are used for sleeping. Be absolutely certain you do not sleep under a fan, heating outlet or situation where air moves over your face during sleep. Make certain you home is humidified in the winter, put a humidity gage in the bedroom. If you cannot maintain a 50-60% humidity put a room humidifier in the bedroom. Run the A/C or heater of your car through the vents on your feet not in your face. Long car or plane trips put your tears in every couple of hours.

If you are menopausal or post-menopausal be sure you and your gynecologist maintain optimal hormonal balance. (Many women with dry eyes have dry mouth and dry vaginal canal). If you have joint pain have that evaluated to be sure you don't have Sjorgren's syndrome. Many medications eg antihistamines can make dry eye worse. You might review your medications with your ophthalmologist.

If you reach a point of exhausting all the above see an ophthalmologist that specializes in "Cornea and External Disease". This is their special area of expertise.

Keep digging and moving forward. I suspect you have not exhausted all the ways you can be helped.