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

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.

[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!!

I made a mistake when editing this, whoops!

One of the members here on the forums, farmgirl, spends a large part of the year there so she's a great source of info!

Here's a link to her profile: http://www.dryeyezone.com/talk/member.php?8900-farmgirl

Saralynn - yes, saw your blog post and thought it was fantastic!! Anyone who doubts that they will be able to enjoy adventurous activities with severely dry eyes should read it for inspiration!

Good to hear that your eyes are wet and nice again and that indeed warrants for celebration! May I know which is better in retaining tears, cautery or permanent plugs?
Are your eyes still scared of wind and aircon after all these years of treatment? Mine definitely do not like wind and aircon and I am contemplating to go Dr G to make scleral lens.

Take care !

I've always been under the impression that cautery will be just as effective as a good-fitting pair of permanent plugs. Obviously the advantage of plugs being it is easily reversible (assuming you use the umbrella-style ones) if you ever want to take a step back.

In my case, due to the fact that I've been dealing with this for years, I doubt I'll ever need it reversed, so prefer the ease of cautery since I no longer have to worry about a plug falling out again. Also, sometimes, even with well-fitted plugs, you feel them a bit when your eyes are having an overly sensitive day... don't have that problem with cautery. That being said, sometimes cautery re-opens and you have to re-do it. My upper right puncta stayed shut after the first cautery, whereas my upper left took 3 cauterizations to stay shut. But, the 1st cautery on a fresh puncta is the worst... re-cauteries (for me anyhow) don't seem to cause as much irritation to the tissue as it heals.

And yes, my eyes still get very irritated by breezes. Part of that is that as treatment has improved my eyes, I irritate them by more and more computer use... but if I had not increased my computer use over the years, I suspect I'd be able to tolerate wind and breezes much better now compared to before.

(I will not see your response for a few weeks as I am about to go trekking in Nepal. But I will certainly take a good look at this thread when I get back.)

Thanks
Neil

Oooo, have fun in Nepal!!!

[neilw]

SAAG
have you thought about trying to stay in Kuching or Kota Kinabalu on Borneo? I am not sure if they get the haze there. We were in KK in December a few years back and the skies seemed very clear. I think the medical facilities may not be as good as on the "mainland" as certainly the locals complained that the government was spending all of its money on the mainland. If you see the new capital they are building near KL you can certainly believe it. But even so, it is not a long flight from KK to KL if one needed good hospitals etc.

And what about living in central America? I know a lot of US citizens go there to retire.

(I will not see your response for a few weeks as I am about to go trekking in Nepal. But I will certainly take a good look at this thread when I get back.)

Thanks
Neil

[saralynn143]

I wrote a weblog post about traveling with a scleral lens: http://www.sarahartman.com/have-scleral-will-travel/

[tealeaf]

Hi SAAG,
Good to hear that your eyes are wet and nice again and that indeed warrants for celebration! May I know which is better in retaining tears, cautery or permanent plugs?
Are your eyes still scared of wind and aircon after all these years of treatment? Mine definitely do not like wind and aircon and I am contemplating to go Dr G to make scleral lens.

Take care !

Update: It's now been about 22 hours since my cautery and all appears normal, based on my past experience with having my uppers done. Still enjoying wet eyes, and hoping things continue to sail along smoothly.

I ended up seeing a corneal specialist here and he cauterized both of my lower puncta shut.

re: long term use of ointment/gel clog the oil - not sure - I've always been unconvinced that they will do that - for me, if I DON'T use them, my eyes become so inflamed and dried out overnight that my MG's get clogged just from THAT experience. But if I use ointment (or gel, back when I could tolerate it), my MG's looked better in the morning compared to if I hadn't used the ointment... presumably because my eyes were less dry and therefore less inflamed overnight.

If I don't get something done to fix this here, then I will definitely look into seeing Dr. Tong in Singapore when we are there in January.

Do you know if there are any good doctors in Singapore who can perform cautery? Now that it's clear I'll want my puncta blocked forever (I've been dealing with this for over 9 years now), I know that cautery is the long-term solution I'm looking for.

[tealeaf]

The ointment I use is preservative-free - all that's in it is white petrolatum and mineral oil.. nothing else.

Oh I didn't know that ointment can be preservative free. Any idea if there is any preservative free eye gel? Will long term use of eye ointment/gel clog the oil?

And on another topic, my left lower plug fell out overnight. GAH! That's my worst fricking eye and it just had to be THAT plug that would fall out. Traitorous piece of silicone that it is... grrrr. Mind you, I had a good run... have had them in for 5 years. So now I will be back to audiobooks, minimizing computer use, and all that old stuff. Sigh.

Sorry to hear that SAAG. Better go get a replacement soon if the eye is getting more uncomfortable. I will tell the doctor the brand and size of the plug I am using to prevent unsuitable one in.
By the way, I have read somewhere in this forum that with all tear ducts being blocked, the eyes will think there are sufficient tears and therefore produce lesser tears to the ocular surface ... any idea is it true???!!!

Mind you, maybe I can get a replacement put in here in Penang? Will have to look into the eye docs here I suppose. If not, maybe I shall see someone in Singapore in Jan... any suggestions on who to see Tealeaf?

For private eye doctor in Singapore, most will recommend temporary eye plugs. If you want permanent eye plugs, can make appointment to go SNEC (Singapore National Eye Centre) and look for Dr Louis Tong. He is the dry eye specialist. IN SNEC, the commonly used plug is Odyssey parasol plug, which I am using. Good and not scratchy.

How many times do you use the device? Daily?

I currently use it about once every 2 or 3 days - during a flare up, I'll use it 4 times per day, and it usually only takes a couple of days to calm things down for me, then I return to once every 2 or 3 days... sometimes even less often. (more info in a previous post in this thread)

I understand that all such gel or ointment are not preservative free, do you have concern about using them for the long term? I use the gel once a day at night before sleep, it seems that I cannot wean it off coz it really lubricates my eye over the long night

The ointment I use is preservative-free - all that's in it is white petrolatum and mineral oil.. nothing else.

And on another topic, my left lower plug fell out overnight. GAH! That's my worst fricking eye and it just had to be THAT plug that would fall out. Traitorous piece of silicone that it is... grrrr. Mind you, I had a good run... have had them in for 5 years. So now I will be back to audiobooks, minimizing computer use, and all that old stuff. Sigh.

Mind you, maybe I can get a replacement put in here in Penang? Will have to look into the eye docs here I suppose. If not, maybe I shall see someone in Singapore in Jan... any suggestions on who to see Tealeaf?

[tealeaf]

Yes, I get it via prescription - it's a compounded drop, made at Leiter's pharmacy in California, prescribed by Dr. Rosenthal. However, if you have compounding pharmacies in Singapore, and can find a dr. willing to prescribe it, it would be worth asking for (worst case if your local compounding pharmacy doesn't have the recipe to make the drops, if you give them the contact info for Leiters, odds are Leiters will share the recipe as a professional courtesy)

Ok, I will check with my doctor. I hope my doctor is willing to give it a try. Some doctors will think they have their own treatment and prefer patients to just follow.

How is the haze in Singapore now? I've been looking at air quality readings, and it's looked worse than what we've been dealing with here in Penang... it must drive your eyes crazy!!!

The haze in Singapore is rather mild. I do not wear any spectacles when outdoor. For this year, the haze came in early Oct and is below 100 PSI. Last year was the worst ever (over the past decade).
Come stay in Singapore! Singapore is a nice place to stay in, safe and clean...... But the standard of living is getting more and more expensive

Yes, it is the exact device I am using, and yes, to reduce inflammation.

2 reasons:
1. if my eyes get irritated from whatever, they get red, so there is a visible sign of inflammation

2. odds are that simply because I have dry eyes, there are at least low levels of inflammation all the time (one of the reasons why steroid drops work so well for dry eye - they are excellent at getting rid of inflammation... too bad they cause cataracts and all kinds of other nonsense if used for too long)

How many times do you use the device? Daily?

My eyes get irritated from any gel I've tried - I used to successfully use Genteal Gel for a years, but for some reason my eyes developed a sensitivity to it, and I've never been able to return to using it, or any other gel.

I understand that all such gel or ointment are not preservative free, do you have concern about using them for the long term? I use the gel once a day at night before sleep, it seems that I cannot wean it off coz it really lubricates my eye over the long night

[DryLondoner]

Today in Penang, we had clear blue skies and I fell in love with this place again - was outside for a quite a while and no eye issues. It'll be interesting to see what the average is like over the next 6 months... plus I'll be asking other people who live here about it whenever the opportunity presents itself. I so WANT this place to be IT - the place where we could have a warm, inexpensive home base... but time will tell I guess...

Here is an excellent link to a real-time world air-quality map: http://aqicn.org/map/world/

Useful to track what you see for any countries of interest over a year or so and see what shows up

I moved to KL in August, it's a massive dusty, polluted and at times haze filled city. I have to say, the haze hasn't irritated my eyes as much I as thought it might. Although we haven't had it that bad yet. Sagg are you using an indoor air-purifier? I have spoken to people who say buy one (or two) and have it on stand-by for those bad days. Also, wet towels under the doors help keep it out.

For me, if it it about humidity vs haze, humidity wins!

Also,