Punctal plugs can provide relief from dry eyes

DEAR DR. ROACH: I’m a 65-yearold female, non-smoker, with very dry eyes living in a dry climate. My eyes often burn and tear up, which I find curious, having been diagnosed with dry eyes.

During the day, I use preservativefree eyedrops and also place a warm washcloth over my eyes. Before bedtime, I apply an ointment or a preservative-free gel (which appears to be the most successful). However, all of the above provide only temporary relief.

My eye doctor has talked to me about punctal plugs that would initially be prior to a permanent solution (they dissolve over time or can be removed). What are your thoughts about these procedures? Would the punctal plugs be tight and uncomfortable? I don’t know anybody who’s had this done and have not been able to find much about success rates.

— S.A. ANSWER: Dry eyes are a very common condition, especially in people living in dry climates. I suspect you may have the most common type, which I’ll discuss here.

Your eyes have three different types of fluids. The first is a longlasting, oily type, secreted by the meibomian glands around the edges of the eyelids near the eyelashes. The second is a watery type, secreted by the large lacrimal glands in each eye near the temple. The third is made from mucus and produced by the lining of the eye, the conjunctiva. Excess watery fluid in the eye drains through the tear duct into the nose.

The warm washcloth your eye doctor recommended helps to open up the meibomian glands, which frequently get clogged up. Without the oily fluid, the tears quickly evaporate in the dry environment, leading to eye irritation and burning.

This paradoxically causes more watery fluid from the lacrimal glands that causes tearing, which explains the curious symptom of watery eyes due to dry eye syndrome. There are several devices to treat blocked meibomian glands.

Artificial tears, gels and ointments are all reasonable first-line treatments. Punctal plugs reduce the loss of eye moisture through the tear ducts. I have had many patients treated with these, and most people do very well with them. I haven’t had people complain about any tightness or discomfort associated with the plugs, but many of my patients have had the plugs fall out, often due to rubbing of the eyes.

Temporary plugs predict the success of a more permanent plug placed by the ophthalmologist for those who do well.

DEAR DR. ROACH: Can those with gout safely take glucosamine/chondroitin supplements?

— R.K.

ANSWER: Gout is a metabolic disease of excess uric acid. It is characterized by crystals that are deposited into body tissues, such as in joints, kidneys and skin. Glucosamine and chondroitin are common supplements taken by people with osteoarthritis. There is not strong evidence that it helps any more than a placebo pill. Fortunately, there is no indication that either glucosamine or chondroitin increases risk for gout, and there is preliminary evidence that chondroitin may help prevent gout.

A patient with many years of gout can be predisposed to permanent joint damage, so managing gout well and early on helps to prevent arthritis.