cautery... my observations...

[patrick]

and what about toxic tears? The minimal tears we produce are not draining into the nose and washing the ocular surface (like car windscreen wipers as we blink). So the same tears are on the eyeball due to blocked puncta's creating possible inflammation?... this is possible for both silicone and cautery.[/QUOTE]

Hi dcrdryeye,

Very valid point you've got there!
Unfortunately i can't answer to that question,because i just lack the knowledge.
Maybe someone here can shed a light on this?
I guess the thing we're all after is to retain as much moisture on the eye surface as we possibly can,but hey what if these tears have the wrong composition and just make things worse?
Maybe for starters the best thing to do is to get as much moisture on the eye as we can (by either plugging or cauterize) and if that is accomplished we have to add some sort of anti inflammatory treatment to the regimen.

Patrick..

[farmgirl]

Like I said, that is why I have refrained from total cautery, although I would be most comfortable with all 4 permanently blocked but those plugs are my 'out' should I develop problems such as 'toxic tears'. So far, so good....F/G

[No tears in ATL]

Hey guys, I have only the top ones done and that seemed to work for me (everyone is different though). I have one smart plug in the upper (yes, I know, risky, but no other plugs would fit in my teeny tiny tear ducts) and the other upper one cauterized. Doc says that he sees infection more in folks who plug the lowers since more of the tears drain from those. I had the lowers done with the three month dissolvables and I swear it did nothing for me. Toxic tears? I have no idea. Tops plugged plus serum tears plus durezol for occasional inflammatory flareup seem to keep me somewhat pain free.

[farmgirl]

Tops plugged plus serum tears plus durezol for occasional inflammatory flareup seem to keep me somewhat pain free.

Glad to hear that No Tears. It takes a lot of trial and error but it is always great when we land that combination that seems work for us. Since we are all different we just need to keep looking and following up on suggestions until we find, through trial and error, what does and does not work. I am happy for you...cheers....F/G

[L8rgator]

Cautery with sutures revisited

I know this is an old thread, but I am also having a tough time with puncta opening up after cauterization. For me cauterization has been the only thing that allowed me not to have to wear a sealed patch all day (I only have one dry eye - due to breaking my cheek bones while sleepwalking - the surgery to fix severed some eye nerves). I had no problem with too many tears, it didn't hurt at all, and I never have any swelling or bruising afterwards. The process looks a little gross, but NOTHING like having painful tarsorrhaphy while awake was - OMG I think I still have PTSD from that! And afterward besides a little black temporary dot I could see in the mirror, nobody could tell.

Unfortunately, my punta just keep opening up. He really tried to "mangle" it last time to ensure it would heavily scar over, but it lasted less than 2 months. I've mentioned cauterization with stitches, but I don't really get a response (don't think my doctors have done it before so are reluctant to talk about it).

I'm very frustrated because I just went to a new doctor and she told me the puncta was closed. I said I didn't think so. Then they she it's wide open. oooookkay? I told her plugs fall out for me in less than 2 weeks (even really really tight ones that took 20 minutes to finally get in). Long story, short she put in dissoluble plugs that slipped in easily without telling me exactly what she was doing. I told her again that wouldn't work for more than 2 weeks, and she said "well we have to see if that will even help. permanent plugs are expensive [yeah I know - they are more expensive when they just FALL OUT AFTER 2 WEEKS!] and we don't have the cauterization tools in this building" and told me to come back in ONE MONTH. ARGH!!!! I feel like she didn't hear a thing I said. Especially when she said half way through "So both eyes were cauterized... huh. Because they are both open now". Um, no, I JUST told you it was one eye and you just told me you had read my whole chart and understood what my problems have been and what the previous doctor did.

I don't want to keep getting cauterized just because I worry all the scarring is forming more of a permanent hole - which will just lead to worse problems. I'd like to push for sutures also, but it sounds like few have had great luck with that either? At this point I've literally considered having my eye sewn shut, as well as spraying pepper spray in my eye just to irritate it for a day (My reflex system and my crying system works fine - it's the basal tears that refuse to flow). Although when I just looked up the term for reflex tears it mentioned onions - I might just have to start carrying an onion around with me

Does anyone have a good doctor in the Wisconsin/midwest region, or in a vacation region of Florida ? I think I need to get to someone with more dry eye expertise.

[DCRdryeye]

It depends on technique. I gave a name to an Australian doctor whom claims she's NEVER had a cauterized puncta open on her. She does suture over the puncta once the cautery is done, thus sealing it further. To suture, the edges need to be roughened a bit otherwise it won't hold, and the cautery does that.

I visited a wonderful, skilled ophthalmologist recently, it was worth flying to the other side of the country for. I mainly flew to see him for Meibomian Gland Probing, but he also used temporary sutures on three of my puncta's to see if permanent cautery will help.

Unlike many of you, I don't want permanent cautery. I am booking into day surgery under light sedation to have 'partial cautery' done by an eye doctor in Sydney. I was advised to wait three months for total healing, then we can use external plugs. My punctums had a three snip procedure and thus extra large. My goal here is to have them reduced to a near normal size and allow fitting of a plug (no plugs fit me at present).

[NotADryEye]

Does anyone have a good doctor in the Wisconsin/midwest region, or in a vacation region of Florida? I think I need to get to someone with more dry eye expertise.

Dr. Steven ****** in Tampa, FL
813-875-0000
www.dr******.com

I live in Orlando and drive to Tampa. His office is a little over an hour away.
Feel free to pm me if you would like more info. He saved my life.

[L8rgator]

After my last message I went back to the doctor that did the original couple cauterizations, and he said that they were still closed, just way down deep. He stuck plugs in the remainder to prove it to me, and yep - they didn't help at all. So I'm at a loss as to why the first times I got the eye cauterized I was 100% better for 2 weeks and 90% better for another 3 or more weeks before all the sudden my eye was back to horrible. I think he thinks the dryness is all my head and drops and the tarsorrhaphy should be good enough, which bothers me more - because when I asked why the heck it worked before he just giggled at me and walked away. Argh. I think maybe the irritation from the burning prompted my eyes to water during the healing process. Or maybe the restasis got down in there when it was raw and that did the trick. I'd do anything to recreate that relief.

This doctor knows nothing about dry eye and says he spends his day doing surgeries trying to open up people's puncta to let more water out so I'm just very unusual and there is nothing he can do. He hasn't even offered any of the tests for dry eye, so I know it's time to seek a specialist - probably out of state.

[MLE]

It took me three different doctors and about 10 attempts to finally get my 4 puncta shut and hopefully permanently shut. I'm glad I had it done vs plugs, but what a horrible process. . .

1. First doctor convinced me to get rid of my 4 plugs (which were working great) and did a "superficial" cautery closure of all 4 puncta. One day later 3/4 of them were back open.
2. Flew back down to see original doctor, stayed a week. Buzzed the remaining puncta closed, the right eye stayed closed. The left opened up, bottom and top 4 MORE TIMES, the final time on the plane home.
3. Saw local occuloplastic surgeon who tried with a laser. Both puncta on left opened back up.
4. Local occuloplastic surgeon performed a suture closure on both puncta on left side. Opened back up.
5. Went to see Dr. Nelson (occuloplastic surgeon) at University of Michigan Kellogg eye center. The laser/suture had created two large fistulas at each of my puncta. She finally, finally got that side to stay closed, I think just by burning the heck out of it.

So it was a terrible ordeal, over many months, but I do prefer cautery over plugs, only because of the risks of a chronic foreign body creating opportunity for infection/inflammation at an already irritated site. And I did have a few issues with my plugs falling out. By some miracle if my tear production ever normalizes I guess I'll be weeping down my face- but at this point I'm not holding my breath for that to happen

-MLE

[Guest]

How long have your puncta stayed shut this time? (particularly the one that you refer to in point#5)