Intracanalicular upper plug didn't work

About a week and a half ago my eye doctor put an intracanalicular plug in my upper tear duct of my right eye.  This was the kind that is suppose to conform to fit.  I have had the other kind of plug three times (that has a cap and sits on top), but it kept falling out.  My lower tear duct is cauterized.  I've never had this kind of plug before.  I have not felt any results from this plug at all ... no build up of tears like I had with the other type of plug.  My eye still feels the same as it did before he put it in as if I had no plug at all and it is very dry and aches badly.  I think the dryness is getting worse.  I can bearly endure this, using lubricating drops about every 15 min and waking up during the night to put drops in.  I also use glaucoma drops (azopt) and I noticed a few minutes after I put azopt in the right eye, I get a hint of taste of it.  I don't think this plug is in there at all, but the doctor said it can't fall out.  My question is if this plug doesn't fall out, can it flush on through by itself?  Or could it have been a defective plug and didn't conform to fit?  I never felt any result of a plug from the first day he put it in.  I have this severe dry eye condition only in my right eye.

[Sandy Feldman, MD, MS]

Dear daisyma,

It is always possible for a plug to dislodge.  You might want to consult your eyeMD to have him/her check the patency of your outflow path.  It is also possible you might need plugs in the superior as well as inferior tear ducts.  Some other options include oral omega 3’s, eye lubricating ointments, and Restasis.  Watch out for preservatives in drops as these can worsen the feeling of dryness.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California