Travel and Dry Eyes (Yes, You Can Even Go to Developing Countries and Survive!)

[Guest]

I made a mistake when editing this, whoops!

[tealeaf]

Hi SAAG,
If i remember correctly, Restasis is about S$60 to S$80.
How are your eyes after cautery? Hope they are still nice and wet
By the way, i am considering permanent silicone plugs for my upper tear ducts, currently have permanent ones in the lowers and temporary ones in the uppers, however, find that my worse eye is still not as good, any idea if a permanent umbrella plug or cautery in the upper duct will provide more relief? Thanks!!

[Guest]

Yeah, eyes are still nice and wet - yippee!!

Well, not sure if your eyes are the same as mine, but for me, my doc did not recommend umbrella plugs for my uppers because the angle of the puncta opening would mean the plugs would rub my eyes and irritate them too much. So for my uppers, he recommended going straight to cautery.

Now if you have a choice (ex. plugs not likely to irritate), then your main considerations as I see are:

1) The hassle of whether or not the plugs will stay put (I got a good run out of mine - they stayed in for 5 years... but others are not so lucky)

2) My lowers usually did not irritate me, and were usually not even noticeable. But occasionally they would irritate mildly, so they are not as comfortable as having nothing there to rub at all. In that sense, cautery wins out since there is nothing sticking out of your puncta to bug your eyes at all. This is one reason I've quite thrilled to finally have all 4 puncta cauterized shut.

3) Cautery, if it stays shut, is a permanent solution - less hassle since they'll be shut forever potentially.

4) Cautery is not exactly a fun time to have done - getting plugs inserted is a cakewalk on the other hand. BUT, honestly, the worst part of the cautery procedure is the injection into (the outside) your eyelid to numb it.. the rest is quite comfortable actually (although I do tend to hold my breath whenever the doctor is actually burning it... I just feel better holding still, although I'm sure the doctor would tell me to just breath already haha) Healing might be a bit uncomfortable at times, but the trick to surviving it at ease is to keep your eyes shut mostly (since if you keep them open you have to blink as usual and every time your lids snap shut for a blink it irritates and brings out the burning sensation from the cautery burn), and take acetaminophen or ibuprofen for pain relief if needed (I've found it helps a ton, makes my lids feel normal while they heal!) Cautery sounds way scarier than it actually is though, so I wouldn't stress about it if you decide to go that route.

Lastly, regarding temp plugs vs. permanent umbrella ones... most people find the umbrella ones do a more complete job of blocking off the puncta and are therefore more effective than the temporary plugs. If given a choice, I'd go for the umbrella permanent ones every time over temps. But you're talking about your upper puncta, right? So if you have the same problem I did with the angle of the puncta, umbrella ones may irritate too much in which case cautery is a great option.

[Rebecca Petris]

Just want to add an additional consideration: RISK. Punctal plugs, yes even the umbrella types, are not complication free. They too can migrate and not be retrievable without surgery, or a fragment of a plug can migrate. I have a dry eye friend locally who recently actually had a very scary episode with massive swelling back toward the sinus that seems to have been possibly traced back to a stray plug fragment (created when some upper plugs were removed) that may have caused an infection of some kind somewhere in the canalicular or NLD system, which spread. She was on an IV drip for awhile and narrowly avoided major surgery. This is the sort of thing my oculoplastic surgeon has made me much more sensitive to as I used to always thing umbrella plugs were the "safe" kind but... there's no free lunch and no plugs that are perfectly safe. Personally I'll never consider plugs of any kind again. I may consider cautery. - I figure no in-office eye-area procedure could be more uncomfortable than my canaliculotomy (!).

[miki-mama]

I was cauterized almost 20 years ago. It was an in-office procedure that lasted less than 15 minutes total. I remember my eyes were swollen and red for about 48 hours, but not much discomfort. I have not had any issues related to the procedure to this day.

[tealeaf]

And yeah, eyes are still nice and wet - yippee!!

So happy for you

Now if you have a choice (ex. plugs not likely to irritate), then your main considerations as I see are:

1) The hassle of whether or not the plugs will stay put (I got a good run out of mine - they stayed in for 5 years... but others are not so lucky)

2) My lowers usually did not irritate me, and were usually not even noticeable. But occasionally they would irritate mildly, so they are not as comfortable as having nothing there to rub at all. In that sense, cautery wins out since there is nothing sticking out of your puncta to bug your eyes at all. This is one reason I've quite thrilled to finally have all 4 puncta cauterized shut.

3) Cautery, if it stays shut, is a permanent solution - less hassle since they'll be shut forever potentially.

4) Cautery is not exactly a fun time to have done - getting plugs inserted is a cakewalk on the other hand. BUT, honestly, the worst part of the cautery procedure is the injection into (the outside) your eyelid to numb it.. the rest is quite comfortable actually (although I do tend to hold my breath whenever the doctor is actually burning it... I just feel better holding still, although I'm sure the doctor would tell me to just breath already haha) Healing might be a bit uncomfortable at times, but the trick to surviving it at ease is to keep your eyes shut mostly (since if you keep them open you have to blink as usual and every time your lids snap shut for a blink it irritates and brings out the burning sensation from the cautery burn), and take acetaminophen or ibuprofen for pain relief if needed (I've found it helps a ton, makes my lids feel normal while they heal!) Cautery sounds way scarier than it actually is though, so I wouldn't stress about it if you decide to go that route.

Lastly, regarding temp plugs vs. permanent umbrella ones... most people find the umbrella ones do a more complete job of blocking off the puncta and are therefore more effective than the temporary plugs. If given a choice, I'd go for the umbrella permanent ones every time over temps. But you're talking about your upper puncta, right? So if you have the same problem I did with the angle of the puncta, umbrella ones may irritate too much in which case cautery is a great option.

Thanks for the details - very useful. This doctor, whom I saw for serum drops, has not mentioned whether my eyes are suitable for upper umbrella plugs, he doesn't seem to like them as he said caused dirt to accumulate around the plugs and may cause infection. He put in temporary ones for my upper. To me, the temporary one helped my worse eye only temporary! (about 1+ week). I may consider cautery for my worse eye.

Someone mentioned with plugs and tears retained, the eyes will think there are sufficient tears and tell the lacrimal gland not to send more tears, I wonder is it true?

I am considering scleral lens from Dr. G. I read about your experience with the PROSE lens and about sensitive sclerals. I am not too sure if my scleral is able to take the lens, is a lot of disappointment plus money if they don't turn out well. Will you still consider scleral lens given that your eyes may have healed more over the years?

[tealeaf]

Rebecca,
Not sure if you have posted more on your experience of canaliculotomy, I am recently done with an operation and now resting at home, thus seldom log into the forum. Is the smart plug completely out? Are your eyes still dry and are you able to wear scleral lens again? I know how much you would want to wear the lens again and have life back to normal. I hope all things work out well for you.

After what you mentioned about the risk of even umbrella plugs, I have my reservation about them Currently, I have 2 lower punctal plugs and they are very comfortable. I may consider cautery for my upper tear ducts but my hubby is suggesting to stay put with temporary ones till I try scleral lens. But I am not too sure if scleral lens will help me. Is a dilemma. I am praying about it. If all things work out well, then I may go to Dr. G for the lens next June.

Have you heard of any complication relating to cautery?

[Guest]

Thanks for the details - very useful. This doctor, whom I saw for serum drops, has not mentioned whether my eyes are suitable for upper umbrella plugs, he doesn't seem to like them as he said caused dirt to accumulate around the plugs and may cause infection. He put in temporary ones for my upper. To me, the temporary one helped my worse eye only temporary! (about 1+ week). I may consider cautery for my worse eye.

Well, there is always a risk with everything. The hard part is figuring out if the risks outweigh the potential benefits for your specific situation.

As far as odds go, odds are LASIK would have been great for me... and it so, so, soooooo wasn't. You win some, you lose some I guess. Cautery has been a HUGE win so far though.

Someone mentioned with plugs and tears retained, the eyes will think there are sufficient tears and tell the lacrimal gland not to send more tears, I wonder is it true?

Sure, it's possible. But I think the vast majority of people feel their eyes are more moist compared to going without plugs and/or cautery.

Will you still consider scleral lens given that your eyes may have healed more over the years?

Nope... I assume since my attempt at the Boston Foundation for Sight didn't work out that I am S.O.L as far as sclerals go.

[tealeaf]

SAAG,
oh didn't know so much negatives about cautery and you did manage to scare me abit..... You are very right about weighing the pros and cons. Guess I will try permanent silicone plugs first if they do not rub against my eyes. So far, the lower ones are doing their jobs well.

One concern about permanent umbrella plug includes having the plugs pulled out successfully without breaking. One eye specialist mentioned that there is a tendency to break an umbrella plug if it is placed in the eye for long. At least the eye specialist in Penang did a good job for you.

Since you are in a humid country now, do your eyes feel fine without wearing moisture chamber glasses? Are they doing better now than in Canada?

[Guest]

SAAG,
oh didn't know so much negatives about cautery and you did manage to scare me abit..... You are very right about weighing the pros and cons. Guess I will try permanent silicone plugs first if they do not rub against my eyes. So far, the lower ones are doing their jobs well.

One concern about permanent umbrella plug includes having the plugs pulled out successfully without breaking. One eye specialist mentioned that there is a tendency to break an umbrella plug if it is placed in the eye for long. At least the eye specialist in Penang did a good job for you.

Yeah, well, crummy stuff can happen with plugs or cautery really. I'm sure I could come up with an equally scary paragraph of things that can go wrong with umbrella plugs if I wanted to hehe

But I think the important thing is to keep any risks in perspective. Yeah, educate yourself about them so you don't go into any treatment blind to the risks. But don't forget to weigh the potential upside too. For a lot of us, we're so badly off that the odds are highly in our favour that we'll drastically improve our comfort with many of the treatment measures out there... even scary cautery.

Since you are in a humid country now, do your eyes feel fine without wearing moisture chamber glasses? Are they doing better now than in Canada?

Well, any improvements in my eyes are mostly used up by me working more on various writing projects on my computer hehe. However, I did go swimming today, and did not wear my moisture chambers - mind you, there was no breeze, so in a way, that's almost like cheating But before anyone gets too excited for me, I did wear swimming goggles when my face was in the water.

On the whole though, for me, a humid climate is heavenly for me compared to the dry winter air I'd be in back home right now. I'm very grateful to be here, and not back home in the cold winter.

[tealeaf]

SAAG,
sometime I am really amazed by how you move on with life joyfully with moisture chamber glasses and drops. These 2 days, I have been feeling rather down as the eyes are no good even in such humid weather. During such times, I would regret my decision on the darn lasik AGAIN and desire to be just like any normal people able to do many things without considering the eyes.

My worse eye is still no good, even with 2 plugs. How do I know if I have MGD? 1 eye doctor says no, 1 says yes but no one express my glands. what did you do to improve your MG? How do you know if there is oil? Is there a need to express the the glands? So many things on my mind ... just hope my eyes will improve to a level like you where I can say wet and nice. In Southeast Asia, fan is required since the weather is hot. Yet, I have to avoid it but my kids need it and I have to be beside to coach them study. I don't think I can fit into any moisture chamber glasses, can't find one in Singapore too.

Thanks for listening to me pour

[Guest]

SAAG,
sometime I am really amazed by how you move on with life joyfully with moisture chamber glasses and drops.

I hope my explanation doesn't offend anyone.. it shouldn't really, since I'm only saying how I feel personally, and not saying anyone else ought to feel this way also...

I've lost any faith in the religion I once had (this happened prior to LASIK... it was something else that set me down this path), so I have no longer have any optimism whatsoever that there is an afterlife - I feel like there are fairly high odds that this is the ONLY life I'll ever get, and so I refuse to waste it. I mean, if there is something more after this life, then it'll be a bonus (if it's something good)... but what if there's not? I just can't waste this one... despite the fact that my (insert colourful word of choice here) eye problems make things much more difficult than they would be otherwise.

These 2 days, I have been feeling rather down as the eyes are no good even in such humid weather. During such times, I would regret my decision on the darn lasik AGAIN and desire to be just like any normal people able to do many things without considering the eyes.

Oh, I regret LASIK every single day... the trick is to practice not thinking about that, since you can't change it... eventually it becomes habit to ignore the regrets. Then you can focus on being happy despite the troubles you have with your eyes.

It has helped me in the past to focus on what I do have, and if need be, think of all the things that would be worse (and trust me, once you get too far going on THAT line of thinking, it's hard NOT to be happy with what you do have.)

My worse eye is still no good, even with 2 plugs. How do I know if I have MGD? 1 eye doctor says no, 1 says yes but no one express my glands.

Maybe both doctors are correct. Perhaps your glands looked great for doctor 1. And perhaps when you saw dr. 2 your MG's were indeed inflamed/blocked or whatever. Mine can change from day to day, even from morning to night sometimes.

If I were you, I'd buy the strongest magnifying mirror you can find - I have a 15x magnification mirror, and it allows me to see the individual openings of my MG's - I can tell if the openings are blocked with whitish thickened mebum, or if they are oozing clear oil when pressed. If your mirror does not have a light on it, then shine a penlight at the glands when looking at them in the mirror - you can monitor your glands quite nicely this way - compare what you see with your mirror to photos you see in online publications aimed at optometrists and ophthamologists.

what did you do to improve your MG?

Trial and error - just keep trying various treatments, monitor the appearance of your glands via your mirror (please do buy one - it helped me figure things out so much more easily since I could monitor the changes myself). There are many possible causes, for example, rosacea (possible to have it only in your lids and not on your face), allergies, or simply have it caused by inflammation that started with your eyes being dry in the first place.

In Southeast Asia, fan is required since the weather is hot. Yet, I have to avoid it but my kids need it and I have to be beside to coach them study. I don't think I can fit into any moisture chamber glasses, can't find one in Singapore too.

Yeah, I know what you mean about the fans - we run ours all the time. Do they have any motorcycle gear shops in Singapore? If so, they might sell sunglasses-style motorcycle goggles. If not, then if you can afford it, I'd spend whatever it costs to buy several different styles of Wiley X's and have them shipped to Singapore if you can. And if not, is taking a vacation to the U.S. (target a city with a Wiley X dealership, have them pre-order what you want ahead of time) and buying them there and option? I know that sounds outrageous to say such a thing, but a well-fitting pair of moisture chamber glasses is worth every penny in terms of the comfort they can give your eyes... if you can afford it.

There is also some good discussion going on here about homemade versions... http://www.dryeyezone.com/talk/showt...please-help-me

Prior to leaving to travel, we went without vacations we would have taken, went without other "extras" we would have spent money on, because we went through a spell where our extra money was used up on treatments for my eyes, many of which failed (ex. thousands spent on scleral lenses at BFS). All that money down the drain peeved me off, but in the long run, was the right thing to spend it on since that is the road I needed to take in order to find a combination of treatments that left me comfortable enough to enjoy life and move on.

I realize one has to balance having enough money for necessities... but one those things are covered, spend what you can on trying things to bring your eyes to a manageable state. Hang in there!!!

[tealeaf]

SAAG,
Very kind of you with the encouraging words, thank you very much Am feeling better today

I hope my explanation doesn't offend anyone.. it shouldn't really, since I'm only saying how I feel personally, and not saying anyone else ought to feel this way also...

I've lost any faith in the religion I once had (this happened prior to LASIK... it was something else that set me down this path), so I have no longer have any optimism whatsoever that there is an afterlife - I feel like there are fairly high odds that this is the ONLY life I'll ever get, and so I refuse to waste it. I mean, if there is something more after this life, then it'll be a bonus (if it's something good)... but what if there's not? I just can't waste this one... despite the fact that my (insert colourful word of choice here) eye problems make things much more difficult than they would be otherwise.

I believe in God but still, I have only this human life, thus I can't waste it too. I keep telling myself I have 3 children, I don't want to live a miserable life, mommy has to be strong for the kids. I want the kids to grow up with a happy mommy.

Oh, I regret LASIK every single day... the trick is to practice not thinking about that, since you can't change it... eventually it becomes habit to ignore the regrets. Then you can focus on being happy despite the troubles you have with your eyes.

It has helped me in the past to focus on what I do have, and if need be, think of all the things that would be worse (and trust me, once you get too far going on THAT line of thinking, it's hard NOT to be happy with what you do have.)

I guess I should try this method.

If I were you, I'd buy the strongest magnifying mirror you can find - I have a 15x magnification mirror, and it allows me to see the individual openings of my MG's - I can tell if the openings are blocked with whitish thickened mebum, or if they are oozing clear oil when pressed. If your mirror does not have a light on it, then shine a penlight at the glands when looking at them in the mirror - you can monitor your glands quite nicely this way - compare what you see with your mirror to photos you see in online publications aimed at optometrists and ophthamologists.

When you have blocked MG openings with whitish thickened mebum, what treatment did you do? Use warm compress and lidscrub? Does Doxycycline help? None of the doctors prescribed me with this.

Yeah, I know what you mean about the fans - we run ours all the time. Do they have any motorcycle gear shops in Singapore? If so, they might sell sunglasses-style motorcycle goggles. If not, then if you can afford it, I'd spend whatever it costs to buy several different styles of Wiley X's and have them shipped to Singapore if you can. And if not, is taking a vacation to the U.S. (target a city with a Wiley X dealership, have them pre-order what you want ahead of time) and buying them there and option? I know that sounds outrageous to say such a thing, but a well-fitting pair of moisture chamber glasses is worth every penny in terms of the comfort they can give your eyes... if you can afford it.

I have a feeling that none of the moisture chamber glasses will fit me as I have asian nose bridge, which is low. Even with spectacles, I have to specifically request for asian fit ones, thus, to-date, I have not requested to have those mositure chamber shipped to me. It is not outrageous, my husband and I are considering to go Texas for scleral lens with Dr G and from there, we will also source for moisture chamber glasses. We will take it as a vacation, to make me feel better.

I realize one has to balance having enough money for necessities... but one those things are covered, spend what you can on trying things to bring your eyes to a manageable state. Hang in there!!!

My supportive husband said the same too. Somehow, I am the one feeling bad that I have to incur so much money on my eyes.

[Guest]

I believe in God but still, I have only this human life, thus I can't waste it too.

hehe... good point!!!

I keep telling myself I have 3 children, I don't want to live a miserable life, mommy has to be strong for the kids. I want the kids to grow up with a happy mommy.

Yes, use that desire to your advantage - sometimes the desire to be strong for others is the only thing that works when the desire to be strong for yourself isn't enough.

And as for my method, you know, the morbid thinking of everything that could be worse, it really does work if you put enough effort into it I also use books for this purpose, you know, ones where whatever the main character is going through is far, far worse than my own troubles. I'm back to listening to audiobooks now... after a few glorious weeks of reading real books, I could no longer deny the downward slide in my eyes, so had to stop. (Mind you, I was reading 3-4 hours per day... so perhaps I went a tad overboard)

It is not outrageous, my husband and I are considering to go Texas for scleral lens with Dr G and from there, we will also source for moisture chamber glasses. We will take it as a vacation, to make me feel better.

Fingers crossed for you!!!

My supportive husband said the same too. Somehow, I am the one feeling bad that I have to incur so much money on my eyes.

Yes, well, no sense feeling bad about something you cannot change. If you and your husband reversed situations, you wouldn't hesitate to spend whatever money was needed to help him too, right? So don't feel bad. When you're feeling better (and someday I'm sure you will be!!!), it not only benefits you, but him too since he won't be worrying about you so much!!!

[neilw]

SAAG
I've just gotten back from Nepal a few days ago so have only just now caught up with your thread. The Nepal trek did not go well for me as I got a bad bronchial/sinus infection, but I did have a good time travelling around Kathmandu and the lowlands (Terai). In Nepal the climate is very dry, very clean air (in the mountains) and very dirty, polluted air in Kathmandu. In the Terai the air is humid with a lot of smoke from burning off. So, overall, not a good place for dry eyes I would think, although there was one huge plus over where we are here in Melbourne. The entire 3 and a half weeks I was there, there was no wind.

Anyway, I was wondering how you were going now. Are you still in Penang and how have you found the smoke haze there ? Are you still finding it to be a good environment for your eyes ? Also have you tried places in the Cameron Highlands ? I would think they would offer a cooler environment while still being humid.

Finally, in an earlier post you mention about needing to use fans inside (obviously bad for your eyes). What about air conditioning ? When we have been in very humid places we have found that air conditioning is not too bad (as far as drying out the atmosphere) unless it is set very, very cold (as they like to do in public buildings in countries like Malaysia).

Neil