Tearing from temporary plugs vs Permanant Punctum Plugs

[ll1988]

Several years ago my lower tear ducts were cautery closed.  The doctor put temporary plugs in the upper ducts to see if it would help to eventually cauterize them too.  But, my eyes teared like I was crying. The first day the one plug popped out and the second day the other stuck out scratching my eye until it popped out too.

Today, another doctor wants to put plugs inside my upper tear ducts.  He said it would expand inside the duct.
Since it is a permanant procedure I am concerned my eyes will tear so bad I have to carry tissues.  I have dry eyes so would like more natural tears.

QUESTIONS:  What experiences & side effects do you have with punctum plugs?  
          
           What is the best punctum plug with least side effects out there?
          
           Can punctum plugs be removed and how?

           Would cautery be better? The other doctor said cautery does not cause infection or irritation down the road.

          

[John C Hagan III, MD, FACS]

A cauthery would be 'irreversible' and if you improved you might be left with a teary eye. I do not like and do not use tear duct plugs that are completely inside the eyelid/lacrimal tubing system.  I have seen several complications from other eye doctors using these plugs. I will not refer to them by name for liability reasons.  I use a plug that has a 'cap' on it that is easy to grasp and remove if trouble develops.

I would only use cautery on all four tear duct openings (puncta) in an eye that was getting scarring and structural damage.

My thoughts would be a easily removable plug and perhaps a trial of Restasis.

JCH MD Ophthalmologist Eye MD

[ll1988]

Thank-you for sharing your experience.  Noted!

What do you think of the hydrogel long term plugs (3yrs)?  They sound more comfortable and can be flused out with saline.

[ll1988]

Can you GENTLY press on an eyelid on top of a nodule on the pupil to eventually flatten it?  Is there anything I can do besides surgery?

My vision is good but the nodule has days it bothers me.
Unfortunately, I did not know dry eyes could grow nodules.  I didn't think I needed eye drops until too late.

[John C Hagan]

Question: Thank-you for sharing your experience. Noted!

What do you think of the hydrogel long term plugs (3yrs)? They sound more comfortable and can be flused out with saline.

Answer: I just finished referring one of those to my favorite oculo-plastic surgeon for surgical excision of one of these plugs. I didn't put the plug in and when it cause a severe inflammatory reaction the "eye doctor" that put them in could not flush them out the lacrimal duct into the nose.

I ONLY use plugs with caps that are removed by simply grasping with a fine pointed forceps. I have not had any serious problem. Of course it's possible for them to come out, this especially seems to happen when washclothes are used to clean the inner part of the eye. I have my patients not do that.

Question: Can you GENTLY press on an eyelid on top of a nodule on the pupil to eventually flatten it? Is there anything I can do besides surgery?

My vision is good but the nodule has days it bothers me.
Unfortunately, I did not know dry eyes could grow nodules. I didn't think I needed eye drops until too late.

Answer: The pupil is a "hole" in the iris. Is the lesion you describe inside the eye? If so it needs to be checked by an Eye MD (Ophthalmologist). If it's on the eyelid, no you cannot flatten a "nodule". If it's in the eyelid it could be a blocked oil gland (Chalazion), or a tumor. You really should have it looked at to establish a diagnosis and then develop a treatment plan.

JCH MD Fellow American College of Surgeons