Punctal Plugs in London or the UK

[Julian]

Hi guys,

Anybody know where I can get Punctal Plugs in London? or the UK?

I have Posterior Blepharitis and dry eye is now well managed but I still cant tolerate lenses. Tried Oasis, moist, tru eye, pro clear, safilens, ortho k with no joy. Am going to try RGP's too.

I want to try plugs to see if they help me tolerate lenses for longer.

Eye doctor i saw on NHS thought my eyes were fine and just to wear my glasses. I really want to get back into lenses so probably going to have to go private for them.

Any ideas on where to go?

Thankyou

Julian

[irish eyes]

Did the NHS eye doctor recommend them? You could always seek another opinion on whether plugs would help you.

I suggest you do a general search on ophthalmologists / optometrists who specialise in Dry Eye treatments. I cannot recommend anyone in London although I'm sure there must be people who could advise you.

It's not an ideal treatment for everyone and I got dreadful infections in my lids when I had 4 punctal plugs. I got them from the NHS - although I'm not being treated by the NHS just now. My current (private) consultant is urging me to give plugs another go but I have refused on account of my horrendous experience in the past.

Sorry I cannot point you to anyone specific.

[angelicab]

Hi there, yes I have punctal plugs which are functioning well for me I realise they don't work for everyone. I see Mr Kumar at Milton Keynes General Hospital. Hope this helps

[indrep]

angelicab
Kestrel medical distributes dry eye products to doctors in the UK. I am sure they could help find a good eye doctor there. I think Maria is the lady to ask.

admin@kestrelmedical.co.uk

01202658444

[littlemermaid]

Julian, We've never seen him but the optometrist Michel Guillon is supposed to be the dude on this http://www.michelguillon.com/. Get a quote, though, it's Sloane Square. I'm not approving of this plugs + contacts idea though, and think you look more fashionable and brainier in glasses.

[Julian]

Thanks so much for all your replies guys.

I have had dry eye since 2009 and saw 3 NHS consultants till i got a diagnosis of Posterior Blepharitis. It is now well managed with Lid Scrubs, Hot Compress, HyloCare eye drops and Systane Lubricant Vials. The 3rd Consultant I saw said I did not need Plugs.

I want to try Plugs simply to get back into Contacts on a social basis. I also only want to try Oasis Form Fit, Mushroom caps and dissolvables. I want to avoid the SmartPlugs and the Intracanicullur ones because of the problems associated with them.

I am going to call Kestrel Medical this week thanks indrep, and will look up the Doctor too angelicab and I have checked out Michel Guillon too thanks littlemermaid.

Irish Eyes, sorry to hear about those infections, What plugs were they? Did the infections cause any long term damage?

angelicab, what plugs did you get?

If anybody reading this has anymore recommendations on someone that does Punctal Plugs in London or nearby or knows of anyone? please let me know

Thanks

[irish eyes]

Julian

I cannot be sure whether my plugs were collagen or silicone. (I have had both over the years).

The plugs themselves were inserted correctly - I had regular checks at the clinic to confirm this. Although I was taking antibiotics, the level of infection remained persistent. Blocking the `channels' meant that there was no means for the bacteria to escape and it resulted in swollen eyelids, infected lashes, chalzion, epiphora....misery.

I willingly accepted the offer of having all 4 puncta plugged because I hoped and prayed it would help but maybe I was one of the unlucky ones. For me it was inappropriate. Looking back, I wonder if the doctors really thought they would help but we had reached a bit of an impasse regarding options and I would have jumped at anything.

Long term damage as a result? I don't know about that really because I still have problems but I might have had these anyway.

[littlemermaid]

Julian,
This is tricky because NHS clinical guidelines for contact lenses are simply contraindicated with dry eye and MGD http://www.evidence.nhs.uk/ so hospital consultants may not get your angle.

Maybe you would be looking for a dry eye optometrist with the clinical knowledge - even then contact lenses are contraindicated with dry eye in optometrist professional guidelines http://www.college-optometrists.org/ and the science is behind the US on treating dry eye with contacts.

Maybe just have to go private for initial advice on plugs/contacts combo, if you are determined, where they are more customer-driven. I would be starting at Moorfields Eye Hospital private, if you are around London, or find a surface disease specialist from a large teaching hospital ophthalmology in convenient private practice. This would need frequent monitoring.

However, any corneal or surface disease department at any NHS teaching hospital should be up to date purely on fitting plugs for dry eye by now, although I do understand your problems with finding the right consultant.

Or you could ask Andrew what he thinks about this in theory, esp regarding co-management of dry eye/surface disease http://www.matheson-optometrists.com - not sure what his available range of plugs is.

[siany]

Hi Julian

Reading your posts I just wondered how you got on with considering plugs? I too have Posterior Blepharitis which I was left with after Lasek eye surgery and a year on after many corneal and abrasions and using many drops (most recent Blink vials and Celluvisc) I still get the dry eye at night which can result in an abrasion. I have now been offered plugs (from laser company) and after reading all the posts Im very doubtful considering how much I have been through this past year with my eyes. Please could you tell me where you buy HyloCare eye drops and Systane as could try them. My main problem is night when I sleep my eyes get stuck so would you recommend any of these to put in before sleep.

Many thanks

[Ahmed]

I would like to chip in here and advise some caution.

If you have blepharitis then its best to treat the blepharitis, plugs do not do that, and if you fit a punctal plug to someone whose only issue is blepharitis, then you have an increased risk of infection, as demonstrated by a patient in this very thread.

You will always find someone who will do a treatment for you at the right price if you look hard enough. This is something I have noticed on this forum, patients seem to be looking for a particular treatment, thinking its the answer to their problems, and when they find someone who will do it for them, they seem disappointed/depressed it hasnt had the desired effect.

regards,

Ahmed.

[irish eyes]

".... If you have blepharitis then its best to treat the blepharitis, plugs do not do that, and if you fit a punctal plug to someone whose only issue is blepharitis, then you have an increased risk of infection....

When talking about treating blepharitis, if it is chronic, then it can only be managed. When I was offered plugs, my issue was not just blepharitis. My eyes were severely dry; MGD was a major contributing factor and it didn't help that I had conjunctivochalis and my eyes were sensitive to most drops. I also suffered with anterior blepharitis but that wasn't anything major. Plugs were offered to me for the correct reasons i.e to conserve as much moisture in the eye as possible.

It is understandable that when a treatment doesn't have the desired effect, we feel disappointed (but wouldn't anyone?) My consultant tells me that it is essential I never lose hope.

[siany]

Hi Ahmed and all

Sorry my mistake I actually have Bilateral dry eyes, after your valid posts I got the hospital letter and seen I had mistaken the two names when reading this thread.
So yes the plugs are purely to treat dry eyes but quite unsure after reading the risks although small. Just wondered if there was another drop I could try for night use, at present I have to set my alarm to squeeze in drops during night whilst eyes still closed in order to avoid an abrasion. Id rather stick with drops than the plugs at mo, just to scared of anymore problems.

cheers guys

[Julian]

Hi Guys,

IRISH EYES sorry to hear about the infections you had. I looked up Chalzions on google and they didn't look like much fun at all. You are right not to give up hope as Dry Eye Treatments are improving all the time and it was well worth having a go, lots of people have posted in forums of PLUGS working for them whether their dry eye is caused by blepharitis, MGD or whatever other cause. It seems your only going to know whether they will work for you or not if you give them a go so I think you did the right thing mate. I hope your eyes get better soon dude.

LITTLE MERMAID thanks for all your advice it has been fantastic, the Mathesons Optometrists looks exactly the type im looking for! Im certainly looking for someone thats customer driven. I have already seen an eye doctor at Moorfields on the NHS who diagnosed dry eyes and sent me off with Celluvisc, so im reluctant to go again. It was my local Consultant who diagnosed the Posterior Blepharitis and it was only after i followed his regime of Lid Scrubs with Bicarb of Soda and Hot Compresses that they really improved. The NHS seems very conservative when it comes to Dry Eye anyway and tend to be reluctant to prescribe long courses of antibiotics to treat Dry Eye disease like in the US and you cant even get Restasis over here yet on NHS prescription. If you do come across any other Plug Specialist by chance please let me know? thanks for everything your a star.

AHMED thanks for you word of caution I do appreciate it. I believe I am already being cautious as I only want to try the Oasis Form Fit, Mushroom caps and dissolvable plugs. I will avoid the SmartPlugs and the Intracanicullur ones. Theres a very strong possibility I also have some form of MGD, Evaporative Dry eye and other forms of Dry Eye as well as Posterior Bleph and as I have already seen 3 NHS consultants with a different diagnosis each, it seems getting a definitive diagnosis as to the cause is very hard in the UK. Also the cost of trying to find a Definite Diagnosis Privately with lab tests etc would cost even more than just trying some Plugs and seeing if they work. After all its not like its Laser Eye Surgery and if the plugs dont work I can take them out.
AHMED are there any long term risks of trying Oasis Form Fit, Mushroom cap or dissolvable plugs if you have blepharitis? are there are any other ways of treating Blepharitis other than Lid Scrubs or Hot Compresses? If you know of any please let me know. I am going to be even more cautious now though and try RGP's Lenses without Plugs first. I have read on forums of posts of people who have different forms of dry eye including blepharitis and have tried plugs and now wear Contact lenses again.

SIANY you should definitley be using Lacrilube at night to lubricate your eyes to help Stop Corneal Abrasions, you could also try ViscoTears which is like a gel which works for others. Are you seeing anyone on the NHS or still just the Doc that lasered your eyes? Muro Opthlamic Ointment is also meant to be good for Corneal Abrasions.
It may be that your Dry Eye could have some MGD or Blepharitis element to it, so theres no harm in trying Lid Scrubs morning and night - Boiled Water (left to cool till warm) with half a teaspoonful of Bicarbonate of Soda powder mixed in then take a cotton bud and just wipe clean above and below your eye lashes. Then you add a Hot Compress for 10 minutes - I use a microwave rice baggy bought off the internet. I did this with no improvement and then suddenly 3 weeks in RELIEF! I had dry eyes since 2009 and had no real relief with loads of different eye drops till i tried the lid scrubs and hot compresses. Try it religiously for a whole month.
Systane Lubricant Eye Preservative Free eye drop vials are great because you can pour half a vial in each eye as many times a day as needed. HyloCare is different and you can only use one or two drops in at a time in each eye but I feel some relief with it. Its easy to look at the eye drops and think 'oh i'll try them then' but for me the Relief has been from the lid scrubs and hot compresses morning and night. I know because if i stop the dry eye irritation is back. Since 2009 i have also taken evening primrose oil 1000mg and omega 3 1000mg fish oil capsules one each a day and a zinc supplement 15mg these have also helped.

SIANY Lacrilube, Viscotears, Systane Lubrciant Vials Preservative Free and Hylocare eye drops are all available on an NHS prescription. You can get Bicarbonate of Soda on NHS prescription or from Chemists. Muro Ointment has to be bought over the counter at Chemists. You can also buy any of the above eye drops online. I am based in Essex too! I hope your eyes get better soon.

Thanks Guys Im going to wait till new year to try plugs now and will also try RGP's without plugs first. If anybody else knows of anyone in London or nearby that specialises in Punctal Plugs please let me know.

[Ahmed]

AHMED thanks for you word of caution I do appreciate it. I believe I am already being cautious as I only want to try the Oasis Form Fit, Mushroom caps and dissolvable plugs. I will avoid the SmartPlugs and the Intracanicullur ones. Theres a very strong possibility I also have some form of MGD, Evaporative Dry eye and other forms of Dry Eye as well as Posterior Bleph and as I have already seen 3 NHS consultants with a different diagnosis each, it seems getting a definitive diagnosis as to the cause is very hard in the UK. Also the cost of trying to find a Definite Diagnosis Privately with lab tests etc would cost even more than just trying some Plugs and seeing if they work. After all its not like its Laser Eye Surgery and if the plugs dont work I can take them out.
AHMED are there any long term risks of trying Oasis Form Fit, Mushroom cap or dissolvable plugs if you have blepharitis? are there are any other ways of treating Blepharitis other than Lid Scrubs or Hot Compresses? If you know of any please let me know. I am going to be even more cautious now though and try RGP's Lenses without Plugs first. I have read on forums of posts of people who have different forms of dry eye including blepharitis and have tried plugs and now wear Contact lenses again..

If you just have belpharitis with no other issues, then plugs are not indicated, however if you have dry eyes or other issues, then plugs may help. I wouldnt worry about the formfit/softplugs.

I also wouldnt worry about the "different" diagnosis, eyes vary etc. In reality different forms of blepharitis rarely exist on their own, and seem to flare up etc so trying to put a label on it is not easy.

The best thing in regards to treatment is to ask the person who examined you, without checking your eyes, I cant say.

I think your plan of RGP first is sensible.

regards,

Ahmed.

[littlemermaid]

Julian, Have you got regular follow-up with your local hosp consultant? This one diagnosed you and gave good advice which improved your eyes. If there are any signs of worsening, you can get referred back. 'Bit of dry eye, use Celluvisc' may worsen without monitoring/advice on regime if bleph isn't well treated, as we all know. Many corneal ophth don't like products, baby shampoo, bicarb, but it's what works for you. Referral through: GP, optometrist, A&E eye clinic if you need it.

[siany]

Julian thank you so so much for all the info, sorry its a late reply too.
Yes Im still under the Laser Company doctor but am seeing an NHS doctor in Moorfields in Jan as really want a second opinion.
I have tried Viscotears at night so will def give Lacrilube a try next, Im also taking Flaxseed oil capsuals(2 a day)
From reading your post I think the lid scrubs is the next thing for me to try,thanks so much for detailing it all.
I had seen a doctor at the laser clinic about the plugs but being my problem is at night when sleeping he felt the plugs would'nt really benefit me anyway as they work with a person blinks.
Thanks for keeping me positive