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Prescribed With Punctual Plugs For Stretching In Eyes And Blurred Vision. What Do You Suggest?

Posted on Sat, 1 Feb 2014

Question: hi , my mother has a eye problem she feels pain blurred vision and when she get up in the morning she feels streching in the eye and she can not open eye properly. doctor advised for a plunctal plugs what do u suggest us ?

Answered by Dr. N K Mishra (2 hours later)

Hi, Thanks for sending your query to us. Punctal plugs are advised to retain tears in cases of dry eye.They are to be preceded by a fair trial of lubricant eye dropslike systane as she was using,which should continue.Tobra DX as shewas using ,at her age is to be avoided unless essential and for a minimum period of time necessary as it's long term use has many complications like cataract and raised pressure. If systane droos do not help alone then punctal plugging is welcome as a addition. do get back to me in case of any further query in this regard.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. N K Mishra (28 minutes later)

Yes punctal plugs might work but my question is that with the punctal plugs the effect of drops will remain long due to very less drainage.she puts a drop that should effect 1 hour or just for few minutes but when she put drops she XXXXXXX t feel anything improved so what will be advantage of plugs. My mother XXXXXXX t want these plugs what should be the other way. R u a eye specialist and where r u from in which hospital do u practice ?

Answered by Dr. N K Mishra (4 hours later)

Dear, Thanks for getting back to us. I have my own set up in lucknow, India where I am practicing eye surgeon for last 30 years. These drops and punctal plug will work if the diagnosis of dry eye is correct. In cases of dry eye,you have to put in lubricant eye drops very frequently and by putting in a punctal plug as the drainage is blocked and the drugs are lost mainly by evaporation and small amount by surrounding cellular absorption,the effect lasts longer. We have to have a correct diagnosis before embarking upon the proper treatment. Can you have another opinion about the exact diagnosis of your mother ? Please do get back to me in case of further query in this regard. Good wishes!!

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. N K Mishra (9 hours later)

Still there is no diagnosis but what doctors say little dryness that may be due to weather and one doctor said that glands are little swelled.ok we go for the punctal plugs what will be the risks and side effects can happen now and in the future? and on thing should we try the first the temporary plugs? or you suggest some eye tests to diagnose properly? thanks

Answered by Dr. N K Mishra (5 hours later)

My Dear, Thanks for getting back to us. There are basically two aspects.One is scirmer's test.This measures the amount of dryness,or reduced wetting of a filter paper strip. Second is a theraputic trial.If there is dryness then it should respond to ocular lubricants. Vogourous lubricant treatment ,if it leads to relief then it is the dryness whic is responsible for the difficulties. This should basically guied us as to the direction we have to take to treat your mother.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. N K Mishra (32 minutes later)

THANK YOU SO MUCH I AM REALLY SATISFIED THE WAY U GUIDED ME. LAST THINGS I WANTED TO KNOW IS THAT HOW THESE TEST WILL BE PERFORMED ARE THEY PAINFUL One is scirmer's test..Second is a theraputic AND I XXXXXXX T UNDERSTAND THIS LINE: Vogourous lubricant treatment ,if it leads to relief then it is the dryness whic is responsible for the difficulties AND PLZ LET ME KNOW WHAT WILL BE HE SIDE EFFECTS OF PUNCTAL PLUGS NOW AND IN THE FUTURE?

Answered by Dr. N K Mishra (3 hours later)

My Dear, what we mean by schimer test is that a strip of blotting paper is touched in the eye and wetting is noted after a time.length of wetting gives you the test reading and details you can google on the net. What we mean by vigerous treatment is that say for example the systen eye drop you were using is a lubricant.If you put in this drop regularly every hour ,this is called vigerous tt. If such tt with eye drops gives you relief that means this may respond better to punctal plug. If there is not much of relief by hourly tt then we have to rethink the diagnosis. I feel i have made my self quiet clear.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar