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Thread: Ongoing and recurring infection from Smart Plugs

  1. #1
    Join Date
    May 2008
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    So. California
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    Ongoing and recurring infection from Smart Plugs

    I would like to ask if anyone here has had an infection and ongoing inflammation resulting from punctal plugs. In particular the brand of “Smart Plug”.

    These are considered permanent plugs and are not detectable once they are inserted. I did not have any irritation for the first year or so with them, but I have now had ongoing problems for over six months and repeated visits and treatments, procedures, and aggressive antibiotics and steroid injections, etc. The doctor has attempted to flush the problem plug out of my upper tear duct, but now suspects it is still in there because the infection keeps returning.

    I am unable to have a special kind of scan to see exactly what it still in there and the next step is to have an actual surgery where they cut and physically remove it. “Cannaliculitis”. The doctor is careful to tell me that this may not even completely eliminate the irritation and more surgery could be needed in the future if it still does not clear up.

    I have had granular things coming out of the upper tear duct that the doctor has also had to physically remove, but it became external and was a part of the resulting irritation. The area in the center of my eye to the upper tear duct is always hard and swollen and hurts. There are various kinds of discharges from puss and blood to dry or gooey substances.

    This doctor has since informed me that she has heard of other people having a problem with the Smart Plug, but not in her practice. She has also said these are all just the “side effects” and regular risks of having plugs put in.

    I have read some of the other threads here on the message board about the various punctal plugs. Yet they are from years ago and none mentioned the kind of plug I have. I am looking to find more information about these plugs and the company that makes them and anyone else that finds this experience unacceptable as a normal side effect. Those of you on this message board will likely understand the concept of “pain and suffering” and can imagine the feelings of discomfort and frustration of such a thing going on and on for over six months with no clear end in sight.

    Please, please comment. I am very alone in my situation and could really use some assurance if nothing else.

    Thank you so much for your time, and thanks for this message board.

    Sincerely,
    Rose

  2. #2

    Yep, been there

    I had the same thing happen with my left plug. (Smart plugs) The right one gave me no problem and eventually disolved or flushed thru or something. My opthalmist was able to physically express the remainer of the plug (and a lot of gunk). Then antibiotics and steriods for about a month all total. It is now o.k.

    I have autoimmune problems and I am of the opinion now that no one with autoimmune problems should have foreign bodies inserted in their eyes. Including implants. I have two total knee replacements and they are giving me as many problems as the eye did.

    Good luck to you.

    Billye

  3. #3
    Join Date
    Oct 2005
    Location
    New Mexico
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    915
    Redbirdi,

    I am glad I never got that type of plug you mentioned. My eye doctor inserted uppers last November, and it caused terrible inflammation, which went away as soon as I had them removed.

    Just 2 weeks ago, the doctor again wanted me to try upper plugs in addition to my lowers. So he put in the temporary collagen plugs. We wanted to test whether the problem last time was just a fluke.

    As soon as the plugs went in, my eyes got inflamed again, and I got blepharitis and infected, too. I also have auto-immune disease, and I HOPE I've learned my lessons about upper plugs.

    Welcome to dry eye talk--I hope you can find some friends here, some support, and maybe a break-through or two. I've been reading and posting here a pretty long time, and it still helps me get through the rough times. Your eye condition sounds so hard to deal with---so severe. I hope things get better for you soon.

    Calli

  4. #4
    Join Date
    Feb 2005
    Location
    Cincinnati, OH
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    1,247
    Rose,

    Make sure our plug expert "Indrep" sees this post. You can send him a private message if you need to. He usually gravitates to the plug questions eventually. He is quite knowledgeable and may have some good advice.

    D
    Never play leapfrog with a unicorn.

  5. #5
    Might you consider cautery? I have collagen plugs in both lowers and one upper and they have helped so much. I am considering going right to cautery for my lowers to avoid what you have all described.

  6. #6
    Join Date
    Feb 2005
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    Cincinnati, OH
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    Cautery is a great idea as well. I am cauterized in all four punctae. Just make sure all plugs have been removed prior to the surgery.

    D
    Never play leapfrog with a unicorn.

  7. #7
    Join Date
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    Rose,

    I'm very sorry that you're facing surgery for this and I wish you the best - especially that they hopefully can resolve it all in a single procedure. I hope you have a really good oculoplastic surgeon. It may make sense to get a second opinion. Personally I would probably do that for almost any surgery if you have the luxury of time before getting it done.

    There are quite a lot of reports in the medical literature (and anecdotally) about problems with SmartPlugs and I've known several people myself who have been through what's happening to you right now. What your doctor says about risk is true HOWEVER a distinction must be made between intracanalicular plugs (inserted all the way into the cannaliculus... where it cannot be seen nor easily removed) versus punctal plugs (tucked into the top of the punctum where you can see the cap yourself and it can be removed easily). Of course many people do well with intracanalicular plugs but if something goes wrong it's much harder to remedy than with punctal plugs.

    Hang in there and keep us abreast of your progress... we'll all be rooting for you!
    Rebecca Petris
    The Dry Eye Zone

  8. #8
    Rebecca, I so appreciate you. Your information is always like the missing puzzle piece for me. I am new enough to this that I thought the Smart Plugs were the basic punctal plug that my doctor suggested. I am really torn about which way to go.

  9. #9
    Join Date
    May 2008
    Location
    So. California
    Posts
    35

    Smile Thanks for Comments...

    Thank you so much to all of you for your comments! As of this moment, I am going to postpone/cancel the surgery. The inflammation is down and the flushing, prodding and steroid shots from last week’s treatment has apparently helped. So far so good. I had it clear up like this before -however in two weeks time it came back with a vengeance. But I just can’t see having surgery if there’s a chance the plug was flushed out finally.

    Rebecca is correct about the fact that I have the intracanalicular plugs. I have never tried to write about this kind of thing before so I’m inclined to get the technical things incorrect. I believe the other type of plugs were tried on me initially but kept falling out. The bottom plugs I could not tolerate the rubbing and constant irritation -it never went away. Removing those plugs was pretty awful too, but it could be done in the Dr’s office.

    Rubbyslippers and Dianat mentioned cautery. I had considered that when I first went to see the eye Dr. She discouraged it, because it is so permanent. Now it seems to only logical next step. As my doctor will admit, I am sooo dry, I will be far more miserable with out being plugged. So I will be searching the community here to read more about that, before going with it. Any directions to the best discussions please let me know.

    Interesting comment Dianat, “Just make sure all plugs have been removed prior to the surgery”. This may be far more complex, as the problem plug was suppose to have been flushed out months ago, but obviously wasn’t. The doctor doesn’t seem to have a sure way of knowing if they’re out? (Other than surgery that requires slicing me open…this also seems too risky?) I can hope I have an experience more like Silverlady now, and be ok.

    But I am still very concerned about all of this and open to more suggestions from all of you.

    Sincerely,
    Rose

    P.S. I also posted a message to “indrep”

  10. #10
    Join Date
    May 2008
    Location
    So. California
    Posts
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    Smile All's well so far...

    So far so good. I made it past 3 weeks and no return of the infection or inflammation. Who ee!

    As long as I’m doing alright no need to see the doctor ‘til July. She said to wait several months before considering the cautery… Still don’t know how we’ll be positive the plugs are out. (I can’t have the contrast dye scan because I’m allergic to the dye).

    I am still very interested in more info on the Smart Plugs, 'cause I have one in the other eye too. Rebecca, if you can give me some more places to search or look into, I’d really appreciate that.

    You have all been so helpful and supportive, I love this Dry Eye Talk! I hope you don’t get tired of me asking lots of questions and posting comments all over the boards. Better than jumping off a bridge!

    Thanks so much!

  11. #11
    Join Date
    Jan 2006
    Location
    Western WA State
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    Quote Originally Posted by Redbirdi View Post
    So far so good. I made it past 3 weeks and no return of the infection or inflammation. Who ee!

    As long as I’m doing alright no need to see the doctor ‘til July. She said to wait several months before considering the cautery… Still don’t know how we’ll be positive the plugs are out. (I can’t have the contrast dye scan because I’m allergic to the dye).

    I am still very interested in more info on the Smart Plugs, 'cause I have one in the other eye too. Rebecca, if you can give me some more places to search or look into, I’d really appreciate that.

    You have all been so helpful and supportive, I love this Dry Eye Talk! I hope you don’t get tired of me asking lots of questions and posting comments all over the boards. Better than jumping off a bridge!

    Thanks so much!
    What brand are your intracanalicular plugs? Mine are Herrick. They are radiopaque which means they will show up on a plain x-ray.
    Every day with DES is like a box of chocolates...You never know what you're going to get.

  12. #12
    Join Date
    May 2008
    Location
    So. California
    Posts
    35

    Smart Plugs

    All I know is they are called Smart Plugs. The doctor claimed that was the name brand and I could find info on the internet. But all I found was electronic switches and auto spark plugs....

    Is Herrick a Smart Plug also?

  13. #13
    Join Date
    Jan 2006
    Location
    Western WA State
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    1,259
    No, they are not the same thing. I do not believe that yours are radiopaque. Here is a link to info about the plug that you have. http://www.medennium.com/prod_dry_eye.htm
    Every day with DES is like a box of chocolates...You never know what you're going to get.

  14. #14
    Join Date
    Jan 2007
    Location
    Outside of Atlanta
    Posts
    272
    I also had a similar experience with Smart Plugs,
    ( Boy are those thing misnamed!)
    I was scheduled for surgery, and backed out during pre-op.
    I kept thinking that they were just going fishing.
    I had different opinions about whether or not the Dacrocysticgram (sp?) x-ray could pick up the plug.
    I had the test done, one Dr, told me it was not there, but a different surgeon said the machine would not be able to detect it.
    Anyway, long story short, The infections eventually cleared,
    I still, do not know where or if any of the 4 plugs are still there.
    A Dr. told me that no reputable Dr will put them in any more.
    Thank God for that!.

  15. #15
    I asked my doctor about them and he said none of the doctors in his clinic will use them.

  16. #16
    Redbirdi
    Unfortunately a few people have experienced what you are experiencing with the Smart Plug. I am assuming this is only happening on one eye. Rebecca said all that needs or can be said. Definitely see an oculoplastic surgeon for second opinion.

    IF you decide against surgery and still believe punctal occlussion is needed for you, Cautery or Form fit plugs could be used. The reason I mention Form Fit plugs is that they, unlike Smart Plugs, when irrigated shred apart like mucous and wash out. BUT before I resorted to either of these I would try a 90 day type plug and see what happened.

  17. #17
    I just wanted to mention that even with three surgeries, the Dr(s) were never able to locate my 'problem plug'. Then two years after the last surgery, it erupted out of my lower eyelid between the inner corner of my eye and my scarred up punctum. Too wierd. I hope things continue to improve for you, Redbirdi!

  18. #18
    Judy were your plugs the golf tee shaped plugs?

  19. #19
    Join Date
    May 2008
    Location
    So. California
    Posts
    35

    Six weeks and alls well!

    Wow, you guys! There are some amazing comments here… Much thanks.

    Six weeks and alls well! I go back for a follow-up with my doctor next week. I was hoping to have some more info to present her with? All I can say is I am so glad I did not have the surgery! I am pretty limited with Dr. choices and getting a 2nd opinion (insurance and hassle). I am really not sure what to do at this point, besides count my blessings!

    Skygoddess, your experience was enlightening and Judy, OMG! That would have put me over the edge for sure… I still wonder if the manufacture of these “SmartPlugs” can be blamed for a faulty product?

    In the mean time, I am not sure what to do about future/further plugging. Do I assume the plug is finally out, ‘cause the infection and irritation is gone, or not? Do I try another kind of plug? Or as my doctor suggests, eventual cautery? Sense I am unsure, I will not likely do anything next week, just see what the Dr. has to say.

    Oh, I don’t know the shape of the plugs, for sure… I never saw them when Dr. put them in. I went to the website that was suggested here in the replies, they looked cylinder shaped?

    Thanks again!
    Rose

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