How can I tell if my punctal plug has fallen out?

[Heiferly]

I have punctal plugs bilaterally in my lower eyelids due to severe dry eye (2 mm on Schirmer's test, each eye), secondary to dysautonomia.  (The possibility of comorbid Sjogren's is still being investigated.)  At any rate, I want to know how I would be able to tell if one of my punctal plugs has fallen out?  I know the obvious answer would be a return of the horrible pain from the corneal damage, but it's not quite as simple as that I fear, because with having to use liquid tears so frequently to replace what my body fails to produce (hourly when awake) and not always being 100% timely with that ... well, sometimes I can't tell.  It's also hard because it's winter and with heat running, that exacerbates things too (especially in small spaces like the car).  I'm just not so SURE I would know confidently that there's a clear difference of it being dramatically worse if the plug fell out, even though I do know my symptoms improved when they were put in.  

Well, I'm also not sure I'm making sense, so I guess I'll just end this here and hope there's some way to definitively check if they're still in place or not?  (I read somewhere that you might be able to "feel" them if you turn your head all the way to one side or something, but I haven't found that to be the case at all.  I stopped being able to notice whatsoever that mine are there within 24 hours of them being put in.)  I just don't want to be walking around having lost one or both of them and possibly be causing myself corneal damage when I should be going back to my neuro-ophthalmologist to get the little bugger(s) replaced.

[EarlTubesocks]

Hi, I realize this post is from years ago but I am going through the same issue as you and I also happen to live in the cleveland area. I have been delaying being checked out by a rheumatologist about Sjogren's Syndrome. I have tried punctal plugs, restasis, omega 3's, and everything else under the sun and still deal with dryness everyday. Just wondering if you ended up having Sjogrens and if there was any new treatment stemming from it. Thanks for any help, if you get this!

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

good luck and Merry Christmas.
JCH MD

[Heiferly]

Thank you very much for your response and tips on dry eye.  I will be seeing a rheumatologist at Cleveland Clinic in January to further pursue whether Sjogren's is part of my problem.  In conjunction with four other specialties there, hopefully we can zero in on better long-term solutions to my symptoms; I will keep your suggestions in mind to inquire about at these appointments.

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

If you were able to see them and now you can't likely they're gone. If you were never able to see them then you will either need to go on symptoms or see your ophthalmologist.

If your eyes are that dry: 1. read the feature review on this page about dry eyes. (General information on Dry eyes; look under the Today's Pulse)   2. you likely should be on restasis 3. you should be taking oral omega 3s (fish oil) 4. you may need to talk about permanently closing the tear duct openings.

JCH MD