The Big Poke.

(Note to those of the medical persuasion: I think puncta is the word I’m looking for, but I’m not sure. If I’m wrong, then it’s the word I’ve made up for the little holes in your eyelids, near your nose, that carry tears away from your eye.)

I relented. I gave in to the suggestion that plugging my puncta would solve my dry eye problems. This despite the failed temporary plug test run a month or two ago. You don’t truly know what it’s like to get poked in the eye until someone as tried to plug your puncta. After yesterday, I now know.

It turns out that puncta plugging is a two step process. First you “size” the puncta to determine what size plug is needed. You begin by instructing the patient to hold still, keep the eye open, and look straight ahead. You then do everything you can to get the patient to disobey. You accomplish this by thrusting a “sizer” into the puncta as forceful as you can without rupturing any soft tissue. Once you have simultaneously sized the suspect puncta, and taken away all of the patient’s hope that this will be easy, you insert the plug. The plugging device is a long thin stick with a small silicone object at the end, and which has “you’ll poke your eye out” written all over it. You retrieve the device and thrust it in a manner similar to step one, only this time, take your time. A little lingering builds the suspense. When you feel the slight popping sensation, stop. To make the experience a little more exciting for the patient, don’t tell them the popping feeling is normal until after the first plug is inserted. This makes for some amusing reactions from your patients. You can almost see the blood returning to their faces when they find out nothing important has a new hole. Now that the plug is in, choose your next words very carefully. They can satisfy the little sadist in all of us. “There, now we’re half done” often works quite nicely. As you may have guessed, I was unable to keep still, keep my eye open, or look straight ahead. I was 0 for 3. Afterwards, the good doctor said that my difficult puncta were in between sizes. He said to me, “I decided to try the smaller ones . . . I didn’t want you to pass out or anything.” To borrow a term favored by one of my co-workers: I’m a woos when it comes to my eyes. But in my defense, that was some major league poking. If I were a prisoner of war, it would have been illegal. . .and I would have talked. This evening when it felt like there was something in my eye, I had the comfort of knowing that there really was.