Eye Plugs

I am a 61 year old female.  About 6 years ago, I had cataract surgery in both eyes.  I have been using various glaucoma drops for about 2 years (currently using Azopt).  I have been told I do not have any glaucoma damage, but my pressures were above the desirable range (over 22) and the drops are for prevention.  About a year and a half ago I developed a dry eye condition in just the right eye.  This was resolved (after trying lubricating drops for awhile) with permanent cauterization of the lower tear duct. (The plug kept coming out.)  Last winter I developed a severe inflamation (inflammation) with bad redness in both eyes.  After trying various drops to clear it up, my eye doctor finally figured out it was a reaction to the glaucoma drops used at that time (Alphagan).  Because I was having discomfort in my right eye at that time, he put a permanent plug in the upper duct and started me on Restasis.  It is now 8 mths later and I have excessive watering in that eye with tears sometimes rolling down my cheek.  The inner corner of the eye has been aching all the time for about a three weeks now.  There is no redness or swelling or sharp pain.  It feels like I am often looking through water until I can wipe it away and wonder if the aching is eyestrain because it gets more intense when I do close up work.  I am continually wiping away the wetness.  My question is, if I now have this much tear production, do I really need the upper plug?  If it is removed, I fear enduring that dry eye pain again. What are the chances it will be that dry again?  Could this excessive wetness be causing the aching in the corner?  Is there any damage risk in removing the plug?  I don't know what kind of plug it is, and I wonder now if I really needed it in the first place.

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

Hello daisyma.  The normal types of plugs that have caps on the top are easily and painlessly removed. There are some types of internal plugs that are hard to remove, hopefully that's not the type you have.  Although Azopt is generally well tolerated, I would discuss with your ophthalmologist stopping it for 2 weeks or so to see if that helped. Alphagan has to be stopped about 8-10% of the time because of redness, irritation and watering. Azopt is a smaller number but it can cause symptoms like you're having. If stopping Azopt helps a great deal consider having selective laser trabeculoplasty to try and get off glaucoma drops completely.

Good luck
JCH III MD