Punctal Plugs for Dry Eyes: Anybody Have These?

[Foggyme]

Hi All. I have very dry eyes / poor tear film and have been experiencing increasing problems with blurred vision (most of the time), gritty eyes, fixed 'floaters', eye pain, and frequent eye infections - despite almost constant use of hypermellose and Actimist eye spray etc.

On Friday the opthamologist inserted some punctual plugs to block the tear ducts and try and improve the tear film.

Just wondering if anybody has any experience of these.

I'd be interested to hear if they improved blurred vision (and how long that took), and if there were any problems or side effects? Oh, and, did they stay in or fall out?

Hoping for a bit of focus and clarity - in the eye department 🙃😄.

Any information or thoughts gratefully received 👍

[pinkandfluffy]

Hello.

I've had 3 x set of plugs. The first fell out after time. The 2nd and 3rd have caused problems in my left eye. The right has been fine. They have helped a little. My consultant suggested I have my ducts cauterized. Sounds scary. I do suffer with blurred vision and floaters sometimes. The plugs have not helped me with that. I use Hylo Forte drops which I've found helpful.

Wishing you and your plugs best wishes x

[Foggyme in reply to pinkandfluffy]

Hi pinkandfluffy. Hmm, so no resounding endorsement, as such...I'm disappointed to hear that the plugs haven't helped with your blurred vision and floaters, and I just bet you are too!

My tear ducts are currently a bit swollen and one of them feels as if something is prickling or scratching it. Don't know if this is due to the procedure (one didn't go in very easily) or whether there is a problem emerging. So, will be keeping a close eye on it (excuse the pun), and also watching out for any brewing infection.

I also think the idea of having the tear ducts cauterised is a bit scary. Not because of the procedure - more because of an ever hopeful thought that the dryness may abate - and wouldn't it then be ironic (and a little soggy) if an excess of tears became a problem 🙃.

Interested in what you say about the Hylo Forte drops. I've only ever used hypermellose and Actimist eye spray, so perhaps the Hylo Forte would be a better option. I'll certainly investigate it.

As to me and my plugs...will we remain paired, moist and happy...well, time will tell, I think.

Have an appointment for review in eight weeks so will reassess then, and will let you know how it goes.

Happy eyes to you 👍

[Barnclown]

Pinkandfluffy's reply fits with most of what I've heard & read about punctual plugs. All that is why I've been vvv relieved my NHS eye clinic consultant chose to offer me something different...this was after 3 years on eye clinic's first line prescription daily dry eye treatments hadn't been enough to manage my dryness signs & symptoms.

My sjogrens dry eye issues came on many years before, in my 30s. I was in my mid 50s when we discovered I'd been diagnosed with lupus in infancy, and I didn't start daily systemic lupus meds until that point (which was 6 years ago). I was referred to eye clinic 2 years after I started on daily lupus meds. Am 63 now.

For 3 years, my first line treatment plan was hyloforte drops + artelac night time gel + meibomian gland dysfunction eye bag treatments. I actually thought/felt this regime was helping quite a lot...and last summer at my annual appt, my ophthalmologist said it was BUT, after in depth examination of my eyes, he said I definitely needed more in order to prevent my filamentary keratopathy from become more severe....and my meniscus/tear film had remained virtually non existent in both eyes...so he could tell my cornea inflammation was much too high.

As a result he prescribed these new cutting edge expensive ciclosporin drops named Ikervis & told me to take them daily alongside the hyloforte + artefacts + MGD treatments too. He had said that if ikervis didn't help enough, he'd have to insert punctual plugs, and then I'd still continue the same combined therapy meds. He saw me every three months at first to monitor my reaction to ikervis. A year later my eyes are feeling better than ever...it's amazing!

So, for the time being: am avoiding punctual plugs. BUT he says my dry eye issues & cornea inflammation will never stop...this treatment plan is just controlling it and protecting my eyes. He continues to see me every 6 months.

I hope something in there is helpful...am sure you can tell this subject is close to my ❤️

So, if you don't get on ok with punctual plugs, could be worth asking about ikervis ciclosporin drops. Please let us know how you get on

🍀🍀🍀🍀 coco

[Foggyme in reply to Barnclown]

Hi Barnclown. Yes, this is all very helpful information indeed😀.

I was caught on the hop with is one. It was a first appointment and I thought I'd just be having an eye examination...but before I knew it the eye plugs were in...and I was out. No time for thought, discussion,or research...hadn't even heard of punctal eye plugs. I have now.

And I'm certainly going to investigate the punctals, see if I can find any research papers...and then take a view. If things don't improve from where they're at now, will have them removed when I go back. If they don't fall out.

I'm not so sure how this is going to go yet. Both tear ducts are currently a little swollen, ones a little 'prickly', and both eyes are itchy. Not sure if this is because of the recent procedure...or because there is an infection brewing. So keeping a close eye on things (😀) and have a quick route access back to the eye clinic, if needed.

I've only ever used hypermellose and Actimist so am very interested in the treatments you've identified (especially the Ciclosporin) so am going to research more about these and discuss them with the opthamologist at the next appointment (if I find that Hylo Forte is non-prescription, will give it a try in the meantime). Have to say, I'm surprised that the opthamologist went for the plugs straight away without trying some different solutions first.

Lucky that the plugs are temporary rather then permenant!

So yes, again, this has all been very helpful. Much food for thought 🍝🍰 so thank you for that 😀.

And again, yes...eyes are close to my heart too...been blurry for so long that a bit of focus and clarity would be a rare gift indeed 😀

Thanks again for your help...I'll let you knew how it goes 👍

[Barnclown in reply to Foggyme]

YIKES...that was a whopper of a first appt 😲...for what it's worth...my cornea expert says that if ikervis doesn't do the job as fully as he'd like it too, he'll also give me punctual plugs (he knows I need to avoid these plugs cause if my primary Immunodeficiency predisposing me to the eye infections plugs sometimes cause).

The British Soviety of Rheumatology Sjogrens Care Guidelines are very good on treatment details re first, second & third line dry eye treatments (all of which apply to lupus patients with sicca symptoms as much as they do to those with secondary sjogrens) and specify ikervis in cases where 3 years of a first line treatment plan have not been sufficient to reduce cornea inflammation, restore enough tear film etc

Wishing you all the best...and looking forward to your updates!

😘🍀😘🍀😘

[Foggyme in reply to Barnclown]

Thanks Barnclown. More good information...will track down the guidelines.

And yes...it's was a whopper...with plugs on (or should I say in) 😀.

Your eyes are now close to my heart too...so will be keeping fingers crossed for all things good. And will watch out for your update too.

Take care 😀

[maur60]

Punctual plugs helped me a little, hylo forte helped a lot and Ikervis has also helped a great deal, although it stings when you first put the drops in. You may need to use it for a few months before you notice a difference, but its worth sticking with it. I found hypermellose made my eyes much much worse, but it works for some people.

[Foggyme in reply to maur60]

Thanks maur60. Interesting what you say about the hypermellose...that's what I've been using, so I wonder if it's making matters worse rather than better 😣.

Barnclown has also recommended the Ikervis (which she says worked really well for her) to, an d both Barnclown and Pinkandflufft have also recommended Hylo Forte, so I'm going to be following up on these.

The punctal plugs are a little scratchy at the moment and tear ducts are a little swollen...but that perhaps because of the recent procedure. Keeping an eye out for infection...just in case...but not there yet. So, I'll be interested to see if these make effect any improvement - fingers crossed and eyes wide open 😀.

Thanks for your help...have a review in eight weeks so I'll let you know how it goes.

👍

[ER66]

Dear Foggyme,

I'm new to is forum and don't have lupus but I was tested for it on my 'road' to diagnosis.

I have sjrogens symptoms. I have severe dry eyes and mouth nd had plugs fitted about 4 months ago. They have definitely helped retain moisture and have stopped the stabbing eye ball pains I was suffering from. Good results for me!

Good luck x

[Foggyme in reply to ER66]

Hi ER66. Yes, me too...new here as well, so hello fellow new one 😀.

Really good to hear that the plugs are working for you: gives me a hope that they'll do similar for me...those stabbing pains are a bit of a beast.

I'm still on the diagnosis route...currently undifferentiated connective tissue disease, possible Lupus / Sjogren's - lip biopsy pending, so we'll see.

It's all a bit of a complex tease, isn't it.

Hope your eyes remain appropriately damp...

👍 X