Experience with severe dry eye and/or punctal plugs?

[Heiferly]

I know we've discussed the dry eye quandary before, but I was hoping we could revisit it because I don't recall the subject of punctal plugs ever coming up before.  (And we all know my powers of recollection are top-notch ... sarcasm, sarcasm.)  

I was sent to consult with my neuro-ophthalmologist due to the persistence (over four weeks) of what I thought was a new symptom:  sudden, dramatic sensations in my left eye as if I'd stuck capsaicin directly in it (the "active" ingredient in hot peppers that makes your eyes burn and water and your nose run if you accidentally touch your eyes after chopping hot peppers without washing your hands well enough).  I mean this was *severe* burning, eyes watering unstoppably, nose running ... the whole nine yards.  You'd think it really was the hot pepper thing except that each time it happened there were no peppers to be seen (or any other irritant I could find or think of) and I wasn't touching my eye (not even absent-mindedly ... I'd have to remove my glasses to get to it, so I'd know).  

Well, it WAS a new symptom in that regard, but when I got it checked out ... it turns out that it mainly boils down to my dry eye being MUCH more severe than I realized.  My doctor pointed out a few different problems that he saw; I think the stuff related to the oil glands on my lower eyelid (which I believe he said is affecting the oil layer of my tear film, for those who have really gotten in-depth in studying dry eye) he has narrowed down to either being related to my seborrheic dermatitis or possibly a just barely onsetting case of rosacea.  So I'll skip that part because I don't think it's particularly relevant to dysauto (though if anyone has similar issues and wants more info, I'm glad to answer questions).  The part pertaining to my question is about my tear production in general.

He did the test where he measured how many mm of tears I produced on those little strips of paper in each eye over the course of 5 min.  He said for a woman my age it should have been (at least?) 10 mm.  When he removed the strips from my eyes at the end of the test, he proclaimed "pathetic!" and showed me the 2 mm each of my eyes had produced.  It was a *very* short discussion between that and the moment when I had my chin resting on that little eye doctor contraption and he was coming at me with what looked like metal tweezers, ready to insert the silicon plugs in my tear ducts!  (Are those called tear ducts where they go?  Geeze, I don't even know.  See?  That goes to show how quickly this all went.  They're tiny holes in the eyelid where the excess tears drain away toward the sinuses/throat.)  I just got the punctal plugs in my lower lids I think.  The procedure wasn't as bad as I expected when I saw him coming at me, and while I could sort of feel them in there at first, I think I'm entirely adjusted to them now (about 24 hours later).  They seem to be working fine and I don't have any overflowing tears, so I guess I really did need them.

I've also been advised to use these expensive eye drops ONCE AN HOUR.  Eek!  I'm going to do battle with the insurance to get them covered.  Hopefully my doc can convince them it's necessary in my case, because I can't afford the quantity I'm going to need OTC.  Interestingly, as I've seen others on here mention Restasis, my neuro-ophthalmologist said I'm not a candidate for Restasis because it's mechanism would be useless to me due to my autonomic nervous system not sending the correct messages to the eye in the first place.  For those who have tried Restasis, has it helped?  Was the doc who Rxed it for you a neuro and/or did s/he have expertise in autonomic?  

Has anyone else tried punctal plugs?  Any complications?  How do you like them?  How much do (or don't) they help?

Like I said, I've only had them for 24 hours, but if anyone is interested in the plugs I'll be happy to answer whatever questions I can (now or after I've had them for longer).

Cheers folks,
Heiferly.

[Heiferly]

beema and LivingInHope,

Thanks for your comments.  I think I will try to get the biopsy (hopefully CC will understand the need for it even if OSU doesn't) and continue battling the insurance to pay for the drops.  Soldier on!  :-p

I'll keep you all updated.  

[LivingInHope]

I have a parent who fought to get Plavix down to a tier two from a tier three co-payment due to problems with HMO's recommended drugs.  What makes HMOs feel fine with taking medicare and premium dollars and then dictating to you and your doctor what drug they think you ought to take for the sake of their bottom line (when they already deduct mega bucks from what medical professional places try to get for their services)?

Let us know how your appointments go?

[beema36]

I have sjogrens. Was diagnosed years ago. My labs at that time were normal but my biopsy they did was positive. You should do the biopsy because i am betting you have sjogrens.

[Heiferly]

Well, I actually got a Rx for OTC eye drops.  He did it that way because the insurance should have to make an exception and pay for them with me not being a candidate for Restasis and I guess there was some other kind of artificial tears that was on my insurance formulary but they also weren't appropriate for me, so the insurance should have to substitute the OTC ones for what's on their formulary in my case.  I'm guessing you've been down this road before (I have, multiple times) ... with the rare disease things, you can twist the insurance's arm to accommodate what your "unique" needs are, but sometimes it's a drawn-out process with a lot of back-and-forth between the doc/hospital and the insurance company.  At least this one isn't an "off label" use so I'm hoping it goes faster than some of the other stuff we've had to push through.  Well, I'm hoping it goes through at all.  Oy.  

I've not been great about putting the drops in, but my home health aides are trying to remember to remind me when they're here, so that helps.  The blood tests for Sjogren's came back negative, but now I've done more research and found out that you can still have it with negative blood work because it may not show up on the blood tests for YEARS and that only this lip/gland (?) biopsy thing is definitive.  So now I wonder if I'll need to have that, since apparently my Schirmer's test was about as bad as it can be.  I'm booked for three specialties at Cleveland Clinic in January, so maybe I can find out up there if I need the biopsy, and if so maybe they'll order it.

It's always something, right?

[LivingInHope]

Aah, liquid (got some out of my purse)

[LivingInHope]

If I remember right, rosacea can happen with vitamin B 2 deficiency.  I have a sibling who had plugs put in tear ducts, but had to have them removed shortly there-after because they were really bothering her big time.  Getting non-preservative eye-drops over the counter is fairly expensive, but likely not as much as the prescription you got?  I have dry eye, but am pretty bad about using eye drops, typically waiting until I've been hurting a while before using any.  I need to go get some.