Punctal Plugs

Question: Where do I go to get punctal plugs? I live in toronto and I've been suffering some pain in both eyes. My doctors gave me eye drops multiple times, taught me to do eye lid hygiene but nothing seems to work. I want to give punctal plugs a try. Anyone know where I can go ask for some? or the process I need to go through to get them. For example can I go to a optometrist to get some.

Answer: Yep, your optometrist is the place to go for that.

Question: How old do you have to be to get punctal plugs? I suffer from dry eye. My contacts get really dry at the end of the day. What is the age limit to getting punctal plugs? NO ANSWERS YET?!

Answer: I do not think that there is an age limit. I am wondering if you should talk to your doctor about it and see what they recommend. There are special types of drops and special contacts for dry eyes available. There are RX drops for dry eye available and also the punctum plug route. Only you and your doctor can figure this out for you. No one here can because there is not way to get enough information, or see your eye or your contacts to give you much advice, hon. Sorry!

Question: Are getting punctal plugs for lasik surgery worth it? went to the eye doc for a screening for lasik surgery. They keep urging me to get punctal plugs (plugs to keep your tears from draining out of your eyes to prevent "dry eyes"). Thing thing is that it costs an extra $150/eye for the plugs. Other option is using rewetting eye drops. $10 vs $300. Is it better to get the plugs, or should I be cheap and use the re-wetting drops? Are there dangers by not doing the plugs? thanks for the help.

Answer: well lasik can cause dry eye, and if you already hace dry eye than the lasik healing process might be slower. you can use the tear drops every hour of the day everyday which can get pricey. or you can get the plugs which a lot of people say its worth it. the plugs can be temporary if you want to try them. there really isnt dangers of not getting the plugs it really is a gimmick or a scam. use the drops.

Question: does anyone have any experience with punctal plugs? My eye doctor recommended plugs in my lower tear ducts to keep the tears in my eyes longer reducing "dry eye", eliminating the need for moisturizing drops. Has anyone done this or know of anyone who has?

Answer: I do it quite regularly and they work well -for people with basic tear insufficiency. If you have any other sort of deficiency - such as blocked glands or a mechanical lid malposition then they are not right for you. I would hope that your doctor has looked at these things before recommending them though. Would be worth asking the questions just to make sure if you're not already.

Question: Does the taking out of punctal plugs hurt? I recently had them inserted into my tear ducts but my eyes produced an unbearable amount of tears which is extremely irritating and obscuring. I'm contemplating on taking them out tomorrow and I was just wondering if this procedure hurts. It was extremely uncomfortable getting them in, I don't particularly predict that getting them out will be a soft journey.

Answer: Sorry this isn't answering your question, but you say it was uncomfortable getting them put in. Just wondering, why? I'm going to be getting it done next week and just wondering what they do. Any info would be great, just email me. thanks

Question: Does it hurt to get punctal plugs in? I'm getting them soon. I'm kinda nervous about it... However I hope it is worth it because it might let me wear contacts.

Answer: If the procedure is done correctly there should be no pain. The doctor should use a topical anesthetic (eye drop that numbs the eye) before he inserts the plugs. With the eyes temporarily numb you will probably feel nothing more than a little bit of pressure when the doctor either dilates the puncta or inserts the plug.

Question: Is discomfort with punctal plugs common? I just had a temporary plug put into one of my tear ducts in one of my eyes and I was just wondering if it's unusual to feel discomfort with it. I can imagine it would be common, but my doctor said that I won't feel it. I can definitely feel it and tell it's there, so i'm just wondering if something is wrong or if i'm just worrying for nothing. I can see part of a peeking out, I don't think that's supposed to happen

Answer: it probably is protruding and rubbing against your cornea keep using artificial tears until you go back to the dr.

Question: Punctal Plugs and Tension Headaches? I suffer from tension headache, painful eyes, fatigue, brain fog, floating vertigo, sensitive and tender skin on my scalp, sometimes slight nausea and sometimes it feels like I was hit on the head with a club a few days ago. I've been to all the doctors. I did have punctal plugs put in before a lot of this started, but that could be a coincidence since this is all happening in my 40s. Can punctal plugs cause these things?

Answer: One is reluctant to say "impossible", these days, but I can't think of one reason, likely or unlikely, why punctal plugs could or would cause such symptoms. Optometrist, retired.

Question: Punctal Plugs hurt and itch!? I've had punctal plugs in my lower tear ducts for about 3 years (I have the kind with a cap on them so they can be easily removed) for treatment of my dry eyes and it seems that they bother me sometimes. My eyes get itchy and swollen at the site and they really haven't helped at all for treating my eyes. I use homeopathic allergy eye drops to ease my itchy eyes, but I am tired of dealing with it. Does anyone have any suggestions? Does anyone know how to prevent discomfort due to the plugs and should I get them removed? That would be $800 down the drain! Are there any better treatments of dry eyes aside from prescription medication? (I cannot take a prescription because I am trying to get pregnant). Thanks!

Answer: Unfortunately dry eyes aren't something that is easy to treat. The punctal plugs should help, but if you find they are irritiating then it may be best to have them removed (although a shame if you have paid for them) Have you tried some thick gel to use at nigth (Lacrilube or Visgel) and then using eye drops to use during the day to 'top up' when your eyes are dry. All are ok to use if pregnant or trying to concieve.

Question: DO PUNCTAL PLUGS STRETCH YOUR TEAR DUCTS ONCE IRRIGATED? I had punctal plugs put in a few months ago and they were only causing irritation so I had them irrigated. The first optometrist was unable to get them out after several attempts and the second was able to but it felt like he really had to tear apart my tear ducts so to speak before the plugs finally squirted out down the back of my throat. In having done all of this, won't my tear ducts now be allowing more of the tears in my eyes out than before I had the plugs in (because of being stretched so much I would have thought :S) and therefore make my eyes even more dry? If you have any idea as to whether or not this is the case or even just an idea as to where I might find an answer I'd greatly appreciate your help, Thanks :)

Answer: They aren't stretched forever - it will tighten up over a few days. Besides, it really wasn't stretched all the much in the first place - it just felt like they were giving you a beating.

Question: Should I get punctal plugs? Recently (last 2 years) I have had a problem with my eyes. The become red and painful. I have been told this is caused by both dry eyes and allergies all throughout the year. Recently I have begun using a mast cell stabilizer (alocril) Which I believe is beginning to work however my eyes are still dry. But it has been mentioned that I could use punctal plugs. Should I go ahead with this. I also war contacts. This has been very troubling as I hate to look people in the eye just in case my eyes are red and I must put artificial tears in my eyes every hour or so which is very annoying. Should I get the plugs or is there another option. I would start with the collagen plugs that go away after a few days to make sure they work for me

Answer: Hi. of course, it's tough to fully advise you on this without the benefit of doing an eye exam, but you very well might have a combination of ocular allergies and dry eye. If you've given the alocril an adequate trial and are still having symptoms, I'd return to your eye doctor to get further exam done. Many run-of-the-mill cases of dry eye are related to problems with the oil glands on the margin of your eyelid. Eyelid hygiene (warm compresses, gently washing your eyelids with baby shampoo while your eyes are closed in the shower) can help. As far as the artificial tears, there are almost too many on the market, lol. For occasional use (4 times or less a day) most any over the counter artificial tears are fine. If you find you need them more frequently, consider preservative-free artificial tears (they come in clear plastic vials). You might also find a gel like Refresh PM (or other equivalent) to be helpful for use right before bed. If these measures don't relieve your symptoms, you may need another exam. Testing can verify whether there is a deficiency of tear production or if there is an underlying medical condition that is affecting your tear glands. As far as the punctal plugs, they are often used after a regimen of over the counter and prescription drops have been tried. Regarding the dissolvable plugs, I don't really use them in my practice. I think the dissolvable ones are kind of a racket...it lets a provider charge you once for the dissolveable plugs, then again for the more permanent silicone ones. If treatment of your dry eye becomes very difficult, I'd recommend seeking the opinion of an ophthalmologist with training in cornea/external disease either by referral or by using the Find and Eye MD search engine on www.aao.org. Hope this helps! -John

Question: What happens if a punctal plug is pushed too far in? I had plugs put in that have a cap on top of the tear duct. My left one kept scratching my eye, so I pushed it down and it went in too far. I tried to push it back out, but no luck. Where does it go? Is it still in there and I just can't see it... I don't want to go back to my doctor since this is the second set.

Answer: It will probably be fine, it will not cause a problem in most cases. Rarely, plugs have to be removed if they are causing an infection, as evidenced by a very swollen, red and painful lid. I can migrate into the nasal sinuses where your tears drain, but from there it would be swallowed (no big deal) or blown out when you blow your nose (no big deal). You might want to consider the Quintess collagen plugs, which are placed into the puncta (into the hole, so they can't scratch), and slowly dissolve over 3-5 months. I have them and I have not had any problems after a few rounds of them. I had trouble with the silicone ones that you have too, they rubbed on my eyes sometimes. You can also consider starting the drug Restasis, which you can use along with plugs to treat dry eye. It's t

Question: Infected Punctal Plug? I had punctal plugs put in a few months ago. About 2 days ago, the left one started feeling kind of irritated, almost like it was scratching my eye. I've never really had any problems so far, and this was the first time that I could really feel it. I assumed that maybe I had just rubbed it too hard or something, so I didn't go to the doctor (like I probably should have!). This morning when I woke up though, there is now a tiny bit of white around the puncta and it fels even more irritated. I called my optometrist, but they are closed of course. Any ideas of what's going on and if I should be concerned enough to take one of their emergency on-call appointments? Otherwise I could wait until Monday. It's not the worst pain I've ever felt, but yes, it is definitely uncomfortable and is beginning to feel even more irritated. You might be right, as it does feel like a scratching.

Answer: Sounds like it might have gotten dislodge a little and was rubbing against your cornea. You notice "white" but does it hurt?

Question: is it possible for a punctal plug to get lost in your tear duct? I had laser surgery about a year ago and the doctor put in permanent punctal plugs to help with the healing when, after 2 months, my eyes were still too dry to heal properly. I've never had an issue with them until yesterday. My eye felt like something was in it. I rubbed and rubbed but it didn't get better so I check the mirror and realized I could no longer see the plug in my right eye's lower duct. Is it possible that it fell out and is stuck somewhere in the folds of my lower eye, or maybe sunk deeper into my tear duct and could be starting and infection? If so, what should I do? It's bothering me. Doesn't really help either that its a holiday weekend and I can't see my opthamologist until Tuesday. Any help?

Answer: It's unlikely if it was fitted properly - and most people are very careful with them because it's very hard to get them out if they go too deep. They are shaped a bit like an umbrella so the end of it won't fit down the hole. It's much more likely that you rubbed it and it fell out. It's easy enough to check for - if you can't see the plug with the microscope you just squirt some fluid down the duct and see what happens - if you feel it in the back of you throat then there's nothing in the way. Nothing is going to happen in the short term anyway - it would take a while for a problem to develop even if it was stuck in there - so don't worry abour waiting until Tuesday.

Question: Has anyone ever had tear duct plugs put in for dry eyes? If so, how did it work for you? Any side effects? I deal with severe dry eye. I can't wear contacts for over a few hours, and I have eye pain throughout the day. Eye docs say I don't have much of an oily layer in my eye. I've tried eyedrops and it just burns to put them in. I'm hoping this punctal occlusion could help me out! Anybody had this perfomed with great results?

Answer: i did wear them. i had lasik surgery and they suggested that they would keep my eyes from drying during a time when it was critical that they be lubricated. you can get chronic dry-eye apparently if after lasik surgery, you dont lubricate, etc... etc. so, the plug in my left eye started to slip out. it scratched, and i could see the thing poking out of the tear duct. i had to get it removed. At first, they tried to manually shove it back down... It was not common that this happen. but i did not notice any results. i dont think it will be a huge difference for you. you could try it, but do temporary dissolving plugs, just in case. hope this helps, sg

Question: Permanent dry eyes due to Accutane? I went on Accutane when I was 14 because I had very severe acne. It made it all go away but I've had very very dry eyes since! I'm only 17 and It is ruining my life. I don't have a gritty feeling in them and it doesn't feel like there is something in them. I do have to blink a lot and kind of crinkle them constantly so as not to let too much air get in them. I am constantly thinking of my eyes and have tried every eye drop out there. Systane included. I did hope that punctal plugs would help but since Accutane attacks the sebaceous (oil-secreting) glands, it seems to me that I don't actually have a tear problem but a Meiobian gland problem (they coat the eye with an oily film). I haven't tried the plugs. I will (I have an appointment) but I have no hope that they will work. Does any doctor know of a cure? No, I'm off Accutane now. I was only on it for a few months when I was 14 but thank you for answering.

Answer: Are you still on Accutane? IF so I would suspect that it would be just as easy to find something else for acne than to get punctal plugs. Tear film is comprised of two things. . oil and tears. You are missing the oil portion of that tear film and therefore your tears are drying out too soon and you have no moisture in your eyes. . . the oil helps the water to sit longer on and in your eye. The plugs will help you to retain what little bit of tearing you are producing and it has it downfall as well. The punctum allows drainage of excessive tear film. . this is why your nose runs when you cry as the nose and punctum are joined together at the back of the nose. When you have the punctum plugged,it is possible that any excessive tears will now run down your face. Like I say,if you are still on Accutane it seems as this would be the easier thing to do to find something else.

Question: Severe dry eye help? I was told by my doctor that I have dry eyes. I have used over the counter dry eye drops and restasis. I have punctal plugs in both eyes and am still extremely bothered daily by my eyes hurting, blurred vision and tired eye feeling. Does any one have any other suggestions. I am having a hard time working my vision is so blurry it takes more time just to use the computer. My doctor doesn't have any more suggestions. I also use flax seed oil as a supplement daily.

Answer: Here is an answer from an earlier question I responded to. Is there any CURE for dry eye? Unfortunately, no. But there are several options available to MANAGE dry eye and make the symptoms more tolerable. 1) Artificial tears. As you have said, though, the benefits are so short lived that most people with moderate to severe dry eye do not do very well with artificial tears. 2) Tear modification. Your other answerer spoke of Restasis. In dry eye that is related to ocular inflammation, significant improvement many times is seen. BUT, it is not a cure. When you stop using the Restasis your symptoms will return. 3) Tear outflow modification. Your tears exit the eye in one of three ways. Evaporation. Spilling out onto the face. Drainage through the lacrimal system in the lids through the punctal openings in each lid. By placing small plugs in the puncta (tear drainage openings) of each lid more of your own natural tears can be maintained to allow better wetting and lubrication of the eye. 4) Nutritional supplements. Some studies have shown improvement in dry eye symptoms for those who take nutritional supplements containing things like Omega 3 fatty acids, flax seed oils, and fish oils. 5) Bacterial flora modification. Some studies have shown an improvement in symptoms by the use of long term low dosage doxycycline oral antibiotics (this is available in a formulation called Periostat -- dentists tend to use it mostly) in combination with long term antiinflammatory drops such as FML. Sometimes one of these can be enough to decrease symptoms to an acceptable level. Other times it may take a combination. And unfortunately, sometimes dry eye can be so severe that with all these combined the problems persist.

Question: Very Dry Eyes.PLEASE help me? I have extremely dry eyes and I've been going from doctor to doctor.They all just tell me to use eye drops. Ok..only helps for a little while. I got punctal plugs put in, but they have made any difference. It's hard to do anything, because I constantly have headaches and my eyes strain. Whether I wear glasses or not, doesn't matter. Any tips-PLEASE. it's hard to enjoy life because of this issue.

Answer: Excessive eye drop use can actually make your eyes worse. Drops temporarily mask your eye and wash away your natural tear film. Make sure you drink TONS of water. I highly suggest you try a product called Natures Tears EyeMist. It is a mist for dry eyes that actually absorbs into your tear film and moisturizes it, instead of masking your eye. And it is a lot easier than a drop. Good luck! And if you are interested in the mist I know you can find it at CVS pharmacies. But I buy it off of Amazon.com

Question: Severe Dry Eyes Help!? I have quite severe dry eyes that are continually getting worse and have been baffling eye doctors for years now. I have punctal plugs in both my bottom and top eye lids, I'm on restasis, I use Thera Tears eye drops 20+ times a day, I have a humidifier running in my room on high constantly, and I am taking fish oil and flax seed oil... and my eyes are still doing horribly and getting steadily worse as they have been doing for the past 4+ years! The eye doctors I have visited say that my eyes don't appear to be very dry at all, but since I have punctal plugs in my eye lids without having tears running down my face all the time proves that my eyes are pretty darn dry. The first eye doctors I went to couldn't even tell I had dry eye and thought I had convergence insufficiency, which I now know isn't the case. I can't play video games at all because my eyes get too dried out after about 45 seconds to keep playing, and it's very hard for me to read and I can't most of the time because of my horrible dry eyes. I have another eye appointment in about two months (the only time I could work it in) and was wondering what I should talk to my eye doctor about, what could cause this to happen, and what more I can do to make my eyes more comfortable. I have spent hours on the internet looking for more ways to improve the state of my eyes and do all of them, and none help very much. I'm pretty sure I don't have an autoimmune disease like Sjogren's Syndrome (I don't have dry mouth), lupis or anything like that. I have also had my thyroid check to see if that could have something to do with it, but it's normal. What can I do? I'm getting desperate, please! I'm only 19 so this isn't aging...

Answer: If you are using any drugs that would be my first guess. If you use too much nasal spray it can actually make your nose run, so it seems possible that using too many eyedrops could cause your tear production to shut down. Also, if you take steroids your testosterone production shuts down. It seems logical that overwetting your eyes all the time could cause your own tear production to shut down. It also might be a problem with the nerves of your eyes, not tear production. Your eyes don't feel dry because they are dry, they feel dry because some nerves on the surface of your eye send signals to your brain. That might be why your doctors say that your eyes are not dry but they still feel very dry. Following this logic, it could also be a small focal seizure in your brain, but this is highly unlikely. It might be a purely neurological problem. Get tested for Sjogren's and for other common autoimmune disease markers- not every autoimmune disease presents in exactly the same way. That's why they are sometimes hard to diagnose.

Question: Haven't been able to wear contacts for nearly 4 months? I've had a chronically dry left eye since the beginning of October, 2009. When I try to put my contact in, it feels like there's a piece of sand under the lens, but not until it is completely touching my eye. I've been able to wear contacts once since then, over winter break, once I'd been on Restasis for a few weeks. The next day, I was completely unable again. I know that dry heat doesn't help, but I've never had this problem in the past. I changed allergy medicines in July, but that would've affected both eyes, and earlier. I'm on flexeril and voltaren for chronic spinal pain, (18 year old female, by the way), and I know flexeril taken long term can have some effects on the eyes, but I've read of nothing like this. My optometrist tried Soothe XP drops at first, then use of those with temporary punctal plugs, and I've been on Restasis with no punctal plugs for nearly 2 months. I don't know what to do, and I am fed up with wearing glasses every day. My blue eyes are so sensitive to sunlight, and I hate not wearing sunglasses. I also ride for the OSU Equestrian Team (although I was just given 6 months no riding so I can get into PT for sacroiliac dysfunction) and it is so uncomfortable to wear glasses under my helmet. Has anyone else had an experience like this, and what did you do? I'm perplexed, with it being in the left eye only, and with the fact that the Restasis hasn't helped yet (with the exception of that one day). Any ideas? Thanks! Also - I've been using Biomedics XC contacts for at least two years. Before that I used different kinds of Acuvue and much prefer the Biomedics. I tried O2 Optics twice and didn't like them. I use Opti-Free contact solution, the brand my doctor recommends. Also - I've been using Biomedics XC contacts for at least two years. Before that I used different kinds of Acuvue and much prefer the Biomedics. I tried O2 Optics twice and didn't like them. I use Opti-Free contact solution, the brand my doctor recommends. Ohio State :)

Answer: It sounds like your optometrist has tried all the appropriate things. I assume with all the other things he has tried, he has also tried different kinds of contacts. You should probably have tried some silicon hydrogel lenses like Acuvue Oasys or Biofinity. You should also have tried some conventional lenses designed for dry eye like Proclear or Proclear dailies. Your dry eyes are surely related to your other auto-immune conditions. It is possible that a round of steroid eye drops might help. You can't take them long term because of potential side effects. I like Optifree as a multi-purpose solution. You may benefit from using Clear Care. We don't use it as much because it is not idiot proof. You don't sound like an idiot so you may want to ask about it.