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My story - blocked tear ducts as a cause or a consequence of dry eye ??

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  • My story - blocked tear ducts as a cause or a consequence of dry eye ??

    What a fantastic forum for people to share their stories, and treatment successes. I would like to post my story and ask for advice people may have.
    I live in Melbourne, Australia (a relatively dry climate, compared to my home town of Sydney, which is more humid). I previously had occasional stinging and watering eyes. Nothing major, it came and went over many years. I could go all year and then have a two-week bout of it, then another several months being fine, then a one week bout. It became a bit more frequent in 2015 and so I got a referral to an ophthalmologist. He found that both of my nasolacrimal ducts were blocked and did DCR surgery on them in June 2015. I guess I should have read up on it a bit more, but he put small silicone tubes in the corners of my eyes to make new channels and allow proper drainage. I could not tolerate the tubes they scratched my eyeballs and he removed them after one week (they should have stayed in place for 6 weeks). Well, my eyes then stung and watered terribly for several weeks. Way worse than before I got the surgery. The surgeon had a look during this time and found that the ducts were still blocked and also noted a granuloma (?. blockage I think) in my nose and I would need the tear duct surgery repeated. Well, over the 7 weeks, my eyes got back to normal. Perhaps I should have stopped then and there, as my eyes were fine, but I trusted the surgeon. He did the surgery again in September 2015. He used different tubes, but unfortunately, again I could not tolerate the tubes. Out they came again, this time only after 1 day. My ducts were still blocked. Sadly, my eyes were then stinging and watering worse than before, just as they had done after the first surgery, and although they improved over time (again, like the first time) they have now yet to recover properly. It is now February 2015, coming up to 5 months after the second surgery. During this difficult time (trying to hold down a new and busy academic post at a University) I set about seeking other opinions. Other optometrist and ophthalmologists diagnosed dry eye. They found these features:
    1. My lower eyelids are inflamed
    2. My lower but not upper- Meibomian glands are a bit poor (drop out of glands).
    3. I seem to have tears pooled at the bottom of my eyes.
    4. My eyes are worse in the morning stinging and watering, but are better at night.
    5. My eyes feel better in warm conditions. (especially when I fly to Sydney, which is warmer and more humid than where I live here in Melbourne)
    6. Not sure what my TBUT is, I think it was OK.


    I have found that the best thing for my eyes is daily FLM steroid drops. I know they should not be used in the long term, but they offer great all day relief for me (mostly). If it ultimately means running the risk of cataracts later in life, I might be willing to take the risk of long term steroid use, as I have great difficulty functioning at work with stinging and watering eyes much of the day. (We assume the watering is reflex tearing).

    So, I am perplexed as to whether the failed tear duct surgery has some how caused this sad state of affairs, or whether my symptoms would have got like this anyway?? There is certainly a very strong correlation with onset of bad stinging and watering eyes each time he did the failed - tear duct surgery. Remember that my eyes got way worse after the first surgery, then recovered to normal, but then went back to way worse after the second surgery. Im wondering if my ducts healed so well that they became fully blocked and now the tears do not drain away at all (maybe they slightly drained before the surgery). Forum member Meibomian suggested that lacrimal ducts could cause dry eyes if they are blocked, so that tears would pool and inflammatory agents build up. This would fit my symptoms exactly. But one optometrist told me that blocked ducts should only cause accumulated tears running down your face, not any STINGNING. But this is a key issue to me, as it should pinpoint the cause of my problem ie, can you get stinging in the eyes from blocked tear ducts???.
    Perhaps I might need to go a third time for the surgery (the surgeon has suggested this, tentatively scheduled for April 2016) and somehow put up with the tubes for 6 weeks???

    The alternative scenario is that the tear ducts became dried up as a result of an underlying dry eye condition they can apparently dry up and block if there are no tears to move down into them and moisten them so the surgeon should never have tried to unblock them, as this would then drain away what little tears I had and make the dry eye worse (This scenario was said to me by one optometrist, who was anti-surgery. ) I guess it would be good to know exactly how much, if any, tear drainage I now have. Syringing with saline at present just rolls back out and down my face, so tear ducts are blocked, but perhaps they are opened just enough to exacerbate an underlying dry eye? (Hence plugs might be the answer??)
    Does anyone have any experience or clues about this?? Just trying to work out whether my blocked tear ducts are a consequence or are the actual cause of my condition.
    Thanks
    Craig

  • WateryDryEyeSF
    replied
    Hi Craig,

    Given the syringing test fails, it is very unlikely the ducts "are opened just enough to exacerbate an underlying dry eye". Here is a very informative reference on lacrimal dilation and syringing which explains what can be learned and how. Note the Jones Dye tests which can give you additional information you are seeking.

    http://www.academy.org.uk/tutorials/dilation.htm

    Blocked tear ducts can lead to eye infection and inflammation (do a Google image search), because the ducts are the intended exit path for most of the junk your tears remove. Whether this is occurring in your case, well experts would be better to determine that.

    I hope you find a solution that works for you. Did you return for the 3rd DCR surgery, and if so how did it go this time?

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