Can someone advise me about punctal plugs?

[bentherebefore]

Can someone help me...

I went to the eye doc and I told him I had rosacea and my eyes were bothering me. He told me I had dry eye and put me on Restasis. I've been taking it for 5 weeks. He has now suggested getting "dissolving" punctal plugs to help more.

First of all, I know some people here have had plugs. Do they help? Most importantly, how much do they cost and does insurance cover them? I would think yes. Any other advise you could give me would be good too.

This doc also said that cauterizing the puncta is a good way to go too, but that kind of scares me. Anyway, please help!!! thanks!

[drums]

Can someone help me...

I went to the eye doc and I told him I had rosacea and my eyes were bothering me. He told me I had dry eye and put me on Restasis. I've been taking it for 5 weeks. He has now suggested getting "dissolving" punctal plugs to help more.

First of all, I know some people here have had plugs. Do they help? Most importantly, how much do they cost and does insurance cover them? I would think yes. Any other advise you could give me would be good too.

This doc also said that cauterizing the puncta is a good way to go too, but that kind of scares me. Anyway, please help!!! thanks!
Dear bentherebefore,
Used to have in the last few years of eight years of rosacea. Thing was it took me a long time to
realise I was actually causing myself to have blepharitis. Thank goodness I realised it soon enough or else I would probably be in a similar situation right now.
Personally I am against IPL, V - BEAM or cauterizing because for me cutting off the blood supply ruins any chance of ever becoming normal ever again. My view is that these treatments are barbaric and only a cosmetic solution due to the ignorance of what rosacea and blepharitis is. The problem you have is that your secreations for your eyes in this case are malformed and therefore toxic. How you deal with that is really entirely up to you but for me sorry; its just a matter of more of my previous posts.

[Melissa W]

Can someone help me...

I went to the eye doc and I told him I had rosacea and my eyes were bothering me. He told me I had dry eye and put me on Restasis. I've been taking it for 5 weeks. He has now suggested getting "dissolving" punctal plugs to help more.

First of all, I know some people here have had plugs. Do they help? Most importantly, how much do they cost and does insurance cover them? I would think yes. Any other advise you could give me would be good too.

This doc also said that cauterizing the puncta is a good way to go too, but that kind of scares me. Anyway, please help!!! thanks!

Hi Ben,
Punctal plugs may help you if you have dry eyes and insurance should cover this procedure. I know a couple of people with ocular rosacea who were helped by the punctal plugs. You would continue using the rewetting drops also. It will allow your eyes to retain the moisture. The literature says that restasis won't help people with punctal plugs but that is untrue. It depends on the individual.
I would do the punctal plugs over the cauterizing. That is more invasive. Punctal plugs are 1, 2,3.

Best wishes,
Melissa

[bentherebefore]

May I ask about how much it costs and how long the procedure takes?

[Melissa W]

Hi Ben,
Here is a brief synopsis about punctal plug insertion that may be helpful.
http://www.dryeyezone.com/encyclopedia/punctalocclusion.html

What is it like to get plugs? Does it hurt?
Punctal plugs are sold with a long tweezer-y looking thing used to insert them. Now, how they are inserted depends partly on what kind of plug they are, for example, some fit right into the top of the punctum (and you can see the caps in the mirror) while others are shoved way down into the canaliculum. But broadly speaking, here is what will happen: Your eye doctor will put in some eyedrops to anaesthetise your eyes. He’ll then use one part of the tweezer-y thing to poke into the puntum and stretch it out a bit. Once it’s ready, he uses the other part of the thing to push the plug into the punctum. Plunk! It’s there. On to the next punctum.
In some cases your eye doctor may have to wrestle with your punctum a little bit to get the plug in. It really shouldn’t hurt at all, but you know, that’s what they told me about my wisdom teeth before the five shots of novocaine and the footprint my dentist left on my face when he braced himself and pulled. If your eye doctor hasn’t done this very often, as was the case with me once, it might be a little uncomfortable, but that's unusual. Really. You should be just fiiiiine.
If you hadn’t already figured this out, the fact is that every time I’ve had plugs put in, it was not my favourite experience, but to be honest I think the anticipation is worse than the fact. My best experience with plug insertion was SmartPlugs, because with those ones they don’t have to stretch open the puncta the way they do with standard plugs. Didn’t feel a thing.
What happens once the plugs are in?
After the anaesthetic wears off, you may be sore from the insertion process. Some people also have a reaction to the plugs that makes them feel uncomfortable - this may even last up to a few days. If this happens to you, please don't despair, don't claw at your eyes and unless it's intolerable don't force your eye doctor to remove them - chances are, the discomfort will pass and in a couple of days you'll feel much better. On the other hand, if you see swelling or have constant pain, by all means call your doctor.
A minority may find that their tears pool up and run over after the plugs are in. There's even a fancy term for it — epiphora (http://www.dryeyezone.com/encyclopedia/epiphora.html). (Now you can really impress your doctor by asking about epiphora before he even puts the plugs in, rather than give him the satisfaction of explaining it to you after you get it.) Personally, I have never had epiphora from plugs, but I know people who did or do. Some people experience significant enough benefits from the plugs that they tolerate the overflow as the price they pay for healthier and/or more comfortable eyes. Too much overflow can be either embarrassing or convenient, depending whether it’s happening during a job interview or while your great aunt is telling you all about her latest hospitalisation. But chronic overflow may be unhealthy as well as inconvenient, so by all means keep your doctor up to date on what's going on.

The procedure is relatively quick. Maybe a few minutes.
Health Insurance should cover this procedure so you should only have a copay to deal with. When you call your eye doctor's office check that with them.

Best wishes,
Melissa

[Melissa W]

Here is an overview of the different types available that you may want to read.

http://www.dryeyezone.com/encyclopedia/plugs.html

http://www.agingeye.net/dryeyes/plugsetc.php

[orchard]

I have had my plugs in for about 5 years now and they have changed my life. I suffered with ulcers, caused by dry eye and was in agony. It didn't matter how many drops I put in, it didn't relieve the pain.

It is not painful to have them inserted and i would highly recommend them.

I live in Britain, so did not have to pay, but would willingly had done anything to relieve this condition

[curlygrl]

Hi,

I have ocular rosacea and flew to NYC to see Dr. Latkany (top corneal specialist). He advises against putting plugs in while there is active inflammation present. Essentially, it would be like putting a plug in a dirty sink. They can be lifesavers for dry eye, but not if there is active inflammation present. You need to control the inflammation first.

As for me, I have lots of redness/inflammation on the surface of my eye (not as much lid involvement). My first opthamologist put them in right away and I think it made my situation worse over the past few months. I had them pulled two months ago.

If you are really wanting to try it out, you can have the doc put in dissolvable plugs (they last 7-10 days). Do not jump to cautery as an option. Very hard to reverse.

Hope this helps,
Carrie

[Melissa W]

Hi Carrie,

Thanks for posting and sharing your experience with punctal plugs with us.
Restasis is great for inflammation and takes about 6 weeks to work so maybe after that(and the inflammation is calmed) you can put in the plugs again and they will help.

Welcome to the forum!

Best wishes,
Melissa