Results of specialist visit

[Mawsky]

Hi All, well I saw the Corneal specialist again yesterday, and he replaced plugs in my lower punctums (I've had DCR surgery so they are huge) He said they may fall out and not to be concerned, I think for now they are in there and doing their job, I already feel my eyes are moist, which they never are. I asked him about me ever having tears again and he feels the answer is yes, that I do but the giant punctums are wisking them away. The question I have is for anyone who may have a similar problem as mine, I had the DCR done years before I developed the severe Dry eyes. Logic tells me they were surely dryer after the procedure but maybe my glands just finially gave up or something, because it seemed that this happened overnight, and I know that probably isn't true. He wants me to retry Restasis, I used it for 6 months with terrible burning and I think some other symptoms as well but I can't be sure, I had so much problem finding the right drops and found I have a sensitivity to all of the ones I've tried out there, but I found that the only drop I can use is Simialsan for Allergies, and the rash and swelling around my eyes is gone now. Has anyone restarted Restasis with good results? I didn't feel it increased my tears at all the first time. I would give anything to feel a real tear run down my cheek again.

[DCRdryeye]

Hey Mawsky, you and I have both had DCR. Did you have both eyes done? I just had the left eye done and as soon as the surgeon removed the tubing after two months...DRY EYE. Then after a few months my right eye started to become dry. I think there's an autoregulation system going on. Yes the lacrimal gland becomes weary of producing too many tears since it's being drained away too quickly and becomes exhausted. And in my case it somehow communicated with the right lacrimal gland and it's doing the same. This is not unusual in the medical field.
I also have MGD, perhaps the tubing introduced bacteria and it affected the meibomian glands?

I've stopped Restasis at 6 months due to no results and it burned my eyeballs, but then caused a lingering burning on lower eyelids. I have restarted and at the 6 month mark again. Still no results, but my plan is to remain on it for 12 months since I've read it can take up to 12 months to work. Secondly, it produces better quality tears. I still don't like it and think it's a useless product. Weighing the risk to benefit ratio, not much benefit, more redness and burning.

No plugs will fit my HUGE left punctas except using DuraPlugs monthly, but is very costly.

[Mawsky]

Hi, thanks for the reply, I'm surprised there are not more of us on here (post DCR) but we may just be the lucky ones, I think I could have seen a real cause and effect if mine had been right away like yours, but I had it done quite a few years prior to the onset of the complete lack of tears thing I've got going on now. They do manage to get some plugs in my punctums, and they did once about a year ago too they last 3 months so not sure if they are the same as yours, lasting only a month would be a pain, I do think they are working as my eyes feel much better, but still once the drops evaporate I need to redrop, I'm going to try and time how often I put them in now and after starting the Restasis (still haven't picked up the RX) Have you looked into having them cauterized? I went back to the plastic surgeon who did my DCR and he said he would like to stitch them closed and see how I did, and if I felt any better before he cauterized them, I saw him 2 years ago but have not been back, just not sure what to do anymore, yes I had both of them done. Are you able to cry tears? I miss that most of all. obviously if I were producing tears I would be happy even if I couldn't get one to roll down my cheek. I don't know what the future holds, but I hate to think of this being a rest of my life sort of thing. One of my biggest fears is being somewhere without my artificial tears, I wear contacts now which help a lot. What have the Docs told you?

[DCRdryeye]

Hi Mawsky, sorry for the late reply. The fact that you developed dry eyes a few years 'after' the DCR may not disclude that DCR caused it. It alters the shape of the eyelids, enlarges the punctas and over time the lacrimal glands get tired of producing too much tears to keep up with the over drainage. It's akin to diabetes type 2, the beta cells in the pancreas get tired of producing too much insulin to keep up with the glucose input. Secondly, how far do they push the eyeball out during the operation, my DCR upper eyelid has a slight laxity in it now.
Not long after my DCR I consulted a female occuloplastic surgeon who "listened" and spent more time with me. She placed the largest plug from eagles, and it came out the next day LOL. DuraPlugs, are temporary plugs and are supposed to last 3 months, but I am feeling way uncomfortable again in 3-4 weeks so get them replaced. I've get 2-3 Duraplugs placed in my largest puncta and always two in the upper, one will not do the job.
Yes I've been told by several ophthalmologist to get the enlarged punctas cauterized. The nice occuloplastic surgeon, whom I'd trust with my eyes offered to cauterize, then suture over. She's never had a cauterization re-open before. But having had surgery stuff my eyes before, I am avoiding it. But it's coming close to that time, where I'll have to have it done out of neccessity and to avoid the monthy visits for Duraplugs. I just don't want to have my eyes "operated" on anymore and you cannot exactly reverse cauterization. I'll keep getting the Duraplugs for now.
Went to a funeral recently, and yes I can cry tears to a certain extent. When I yawn, I feel nothing.
I have the same fear as you, being somewhere without my moisture chamber glasses (I cannot do without those) and my artificial tears.
The docs just tell me to continue restasis. My next visit with Australians noted dry eye specialist is next week (have to fly to get there). So we'll see how we go.

[Mawsky]

Please let me know what you find out after your visit with the Ausie Doc, Would love to hear you got some answers. I know what you mean about not wanting to do anything else that may make things worse. I've read a few post on here that some have had problems with Cautery, If I knew it would fix my issues I would have done it two years ago. I've just never gotten any real answers, and given that you can cry you are a step ahead of me, I have not had anything but an artificial tear run down my check in over two years now...actually I've lost count maybe three years ;(

[sunshinelover]

Please let me know what you find out after your visit with the Ausie Doc, Would love to hear you got some answers. I know what you mean about not wanting to do anything else that may make things worse. I've read a few post on here that some have had problems with Cautery, If I knew it would fix my issues I would have done it two years ago. I've just never gotten any real answers, and given that you can cry you are a step ahead of me, I have not had anything but an artificial tear run down my check in over two years now...actually I've lost count maybe three years ;(

Masky,
Have you got any answer frpm any doc as to why onöly a few of your meibomian glands are working? I have not understood myself why they stop working if they are not clogged.

[Mawsky]

Hi Sunshine! Actually I've never been told my Meibomian glands don't work. I dont have MGD or at least have never been told I do, my Lacrymal glands are not producing tears, so that may be my only problem right now. Just no tears.

[DCRdryeye]

Hi Mawsky, I wanted to give you an update from my latest appointment from Australias leading dry eye specialist...but we had a deluge of rain and it flooded our town so I could not get to the airport to see him. That was two days ago, now it's a bright sunny day. Grrrrrrr and my car now needs thousands of dollars of repairs from driving through flood waters to get from one end of town to the other. So I may have to ease up on expensive eye treatments for awhile...it's not as if they are doing anything anyway.

[Mawsky]

Darn it anyways, I'm so sorry you did not get to your appointment. Will you be making another attempt in the future? I'm sorry to hear about your car, I hope they can get it fixed for you soon. What a shame, I started the Restasis, but only put in two drops first at night and again in the morning, my eyes had been irritated already, so they were really bad after just two drops, my eyes have been pretty OK the last few days, so I put in a drop this morning, my eyes are slightly burning right now (4pm) and I put the drop in at 10:00 am, but I'm hoping that this is the worse it gets, I told myself I would really try them this time, but want to be sure that my eyes are OK when I start them so I can really judge. It's so crazy when I put the drop in they don't burn until about 15 minutes later, but they keep burning for at least an hour or two after that, I don't know how normal that is?? Do you think the Restasis has help with your tear production? And do you think the burning becomes less so as time goes on? I will let you know how it progresses. Hope you don't have anymore rain for awhile
Christine

[DCRdryeye]

Darn it anyways, I'm so sorry you did not get to your appointment. Will you be making another attempt in the future? I'm sorry to hear about your car, I hope they can get it fixed for you soon. What a shame, I started the Restasis, but only put in two drops first at night and again in the morning, my eyes had been irritated already, so they were really bad after just two drops, my eyes have been pretty OK the last few days, so I put in a drop this morning, my eyes are slightly burning right now (4pm) and I put the drop in at 10:00 am, but I'm hoping that this is the worse it gets, I told myself I would really try them this time, but want to be sure that my eyes are OK when I start them so I can really judge. It's so crazy when I put the drop in they don't burn until about 15 minutes later, but they keep burning for at least an hour or two after that, I don't know how normal that is?? Do you think the Restasis has help with your tear production? And do you think the burning becomes less so as time goes on? I will let you know how it progresses. Hope you don't have anymore rain for awhile
Christine

Yes I've reschuded another appointment with the dry eye doc, now have to organize flights. So many things. With restasis, I don't recommend applying Refresh Plus on first as another member said. The stinging DOES diminish after awhile. I was told after 20 minutes of applying restasis you can apply artificial tears in, so use the tears that seem most soothing to you and that may reduce the burning. When my eyelids burn like peppers, I find Celluvisc helps a lot (I use a whole vial per eye - saturate them. Close the eyes for a few seconds). If not, I'll wait a awhile and splash them with cold water (splash them with water anyway even before applying artificial tears to remove debris and the coolness with help the burning). Experiment with other artificial tears, sodium hyalorunate may help, or FreshKote. Something must remove the burning, no need to put up with it all day

Now I might be doing the other member a diservice here. My dry eye doc gets me to apply a non preserved steroid drop (they come in vials), and told me to wait 5- 20 minutes before applying Restasis. I like to wait about 10 minutes or more because the steroid drops are SO soothing. But he did say there's no need to wait for 20 minutes. However, the steroid drop is not as thick as some of the artificial tears out there and I'd prefer to get permission from an ophthalmologist first before using arificial tears before Restasis.