Had uppers cauterized... my experience

[RobLIC]

SAAG .... your posts are actually filling me with joy! I think cautery was one of the best things I did. And if you approach it methodically, i.e. not doing all four at once, it can be a major help in achieving a more comfortable life. The burning will exist because the cautery is preserving more aqueous tears, not changing the lipid/amino acid component of the paste-like oil. But that's why we have cod liver oil and doxycycline - to help break that down ... continued good luck! Rob

[Guest]

So I got replugged today and now that I know the plug actually helped, he plugged the right eye, too. I asked him if they popped out again if he would consider cautery on me and he said "absolutely." Woohoo! So next time these babies fall out I'm scheduling cautery.

Since you noticed good relief with the temporary plugs, then having something more permanent (whether a permanent plug or cautery) should help even more. I know they say temporary plugs don't block 100% of the puncta, but I was still shocked by how much wetter I am with cauterized uppers compared to just temporary plugs up there.

SAAG .... your posts are actually filling me with joy! I think cautery was one of the best things I did.

So are you cauterized in all 4 ducts Rob? or just 2? (I only have the uppers cauterized, since I have permanent plugs in my lowers) Since it was one of the best things you did, I assume you are doing much better now, which is great news!

The burning will exist because the cautery is preserving more aqueous tears, not changing the lipid/amino acid component of the paste-like oil. But that's why we have cod liver oil and doxycycline - to help break that down ... continued good luck! Rob

I'm working aggressively to fix my MG's in my right eye - that's the one that has been the bane of my existence since LASIK. I now believe it was so bad because my eyes are so crazy aqueous deficient that even a relatively minor amount of MG dysfunction had a large effect on my comfort levels... there just wasn't enough moisture to dilute the effect of those soapy lipids.

Having all this moisture now is helping immensely though - instead of burning in my right eye, normally all I get now since cautery is periodic feeling like there's a film over that eye... hard to describe...

Anyhow, for my MG's, I've started IPL with a local dermatologist. I showed her an article by Dr. Toyos where he details his procedure, and she said she'd give it a try. The only thing she won't be doing is the gland expression - but since my MG's aren't that bad (so say my optometrist and corneal specialist), I think there is hope for them to clear up without a Dr. Toyos-style gland expression. I think my MG's on my left eye look completely normal now... but there are still a few MG's on my right eye that are stubbornly resisting my attempts to normalize them. Hopefully the IPL will fix them!

Since I have rosacea too, I got them to do the IPL on my entire face. Man, it freaking HURTS though!! I was squealing like a baby lol Thankfully, the treatment didn't take too long! I was joking with the technician that I hoped we were in a soundproof room because I'd scare off the other patients haha The technician said that most people squeal though, so maybe I'm not a total wimp

I watched a video on youtube where IPL was being demo'd for a TV news feature, and the patient looked totally relaxed as if she was getting a massage or something... they must have had the IPL machine turned WAY down so that the news feature wouldn't scare away patients lol

[grandsporta]

I don't mean to sound ignorant, but what does this procedure do?

[RobLIC]

I'm cauterized in three, for some reason that made sense at the time. The lonely uncauterized duct - lower right - has always been so swollen that it wouldn't even take a plug, so we think of it as naturally closed

[Lucy]

Rob, I'm you in reverse. I am cauterised on one puncta(um). One has a plub and the two lowers are scarred shut.

[Guest]

Just another update... the itching in the inner corners of my eyes has been lessening each day... the past 2 days I've had zero itching there... I'm wondering if the itching was caused by the cautery area healing? I'm thinking maybe it's like when you have a wound anywhere else, and it itches a bit as it heals??

I don't mean to sound ignorant, but what does this procedure do?

No worries! You don't sound ignorant at all!

Here's a link to an article that tells a bit about IPL... just scroll down to the heading " Light treatments for dry eye"

http://www.eyeworld.org/article.php?...ologic=&query=

[willwork4tears]

[QUOTE=SAAG;50174]Just another update... the itching in the inner corners of my eyes has been lessening each day... the past 2 days I've had zero itching there... I'm wondering if the itching was caused by the cautery area healing? I'm thinking maybe it's like when you have a wound anywhere else, and it itches a bit as it heals??

/QUOTE]

That's exactly what I was thinking! The itching is probably the normal healing process. It always itches the worst when it's ALMOST done healing.

[grandsporta]

Just another update... the itching in the inner corners of my eyes has been lessening each day... the past 2 days I've had zero itching there... I'm wondering if the itching was caused by the cautery area healing? I'm thinking maybe it's like when you have a wound anywhere else, and it itches a bit as it heals??



No worries! You don't sound ignorant at all!

Here's a link to an article that tells a bit about IPL... just scroll down to the heading " Light treatments for dry eye"

http://www.eyeworld.org/article.php?...ologic=&query=

It says its for non-immune entiology. I guess it wouldn't be for people who had SJS.

[mary kenny badami]

SAAG, thank you very much for reporting your experience about the process (mysterious to us non-docs) called "cauterization" or "cautery,"
which electrically or otherwise closes one or more of the four tiny drainage tubes -- two up, two down -- at the nasal side of our eyes, which are called "puncti."

I explored cautery several years ago as a possible remedy for my post-Lasik dry eyes;
however, during the pre-op examination I found that particular eye doc to be so cold and dismissive about my concerns that I cancelled the followup appointment to actually have it done.

Nevertheless, Dr. Sandra Brown spoke persuasively at a Dry Eye Zone-hosted conference a few years ago,
saying that IF temporary or regular plugs were working well and the patient wanted more permanent closure, cautery might be a sensible option for someone with dry eyes.

I appreciate patient-perspective-descriptions of their surgeries/ procedures, etc.
Thank you for taking the time to describe it so thoroughly, as well as for your candid updates.

[spmcc]

I'm curious... is there any reason why cautery would work better than plugs (besides the plugs dissolving or falling out)? Does it do something different that plugs don't?

[indrep]

difference between plugs and cautery

The goal of punctal occlusion is to keep more tears on the ocular surface. This allows the patient to feel more comfortable and hopefully reverse the osmolarity of the tear film to normal levels eliminating the inflammatory process.

The differences between cautery and plugs is cautery alters the tissue of the canaliculus (the drain tube that runs from your puncta to the nasal area). This creates scar tissue and can create a sense of irritation. Punctal plugs while sometimes described as permanent are really "long term" solutions that do not alter the tissue and can be removed if necessary.

Studies have shown that cauterized puncta "reopen" at a rate of around 50%. Some studies show less some more. I know from experience that if puncta are not properly measured and the correct size plug inserted "fall out" rates can be quite high. If measured and properly fitted the retention rate for plugs 90-95%.

So the differences really come down to do you want a permanent alteration of tissue that could impede future treatment or a long term solution that can be reversed if necessary.

I hope this helps.

[amyk]

Can plugs help with oils/MGD?

Indrep,
Can cauterized puncta be reopened if wanted? I haven't tried plugs, but was told that my lid margins turn inward and plugs would probably irritate my eyes. That may reduce the possibility of plugs.

Also, you mentioned that plugs may help eliminate the inflammatory process. Could they help reduce inflammation of the eyelids (and therefore help with MGD) or just inflammation in the eye itself?

[indrep]

amy
yes cauterized puncta/canaliculus can be reopened with another surgical procedure that can leave a visible scar along nose. You would probably not be a candidate for silicone plugs. You have two options, 90 day plugs replaced every 90-100 days or a hydrogel plug called Form Fit. Both of these fit inside the punctal ring and would not rub your sclera or cornea.

As to helping inflammation of the lids I am not sure. Most literature talks about ocular surface inflammation being caused by hypertonic tears. MGD has other factors as causes.

[Guest]

Well, I'm almost a month out from my cautery procedure, so I thought I'd update this thread one last time.

So... in the last couple of weeks, I had to go back to using goggles... don't know what happened....

Probably several factors were involved...
1) Since cautery, rather than using Restasis 4 times a day religiously, I was only using it 3 times per day, and on the one day a week that I would work a longer shift, I only used it twice.

2) I had IPL via my dermatologist 2 days post-cautery - maybe that made my eyes temporarily wetter than they would have been otherwise??

Woke up one Monday morning (after working a 7 hour shift the previous day), and my eyes were dry again... NOT as bad as pre-cautery, but dry enough that I decided to put the 'ol goggles back on for around the house. I re-started using Restasis religiously 4 times daily, re-started using cold compresses for 10-30 minutes 4 times per day and hoped for the best.

So, as of now, I'm still wearing goggles, but my eyes have improved over the past 2 weeks.

All in all, I'm glad I did the cautery, because my eyes are definitely wetter than they were pre-cautery. The extra moisture allows them to recover more quickly from tough days (ex. work!), and I can watch TV and use the computer (still limiting myself to 2 hours per day max!) in more comfort than before. I've healed nicely, so no complaints. But, obviously I could still use even MORE improvement, so hopefully I'll find some of that!

[sighthound]

Glad to hear the cautery help you. I think it is normal to be really wet for the first little while and then go backwards a bit. My eyes were dripping when I first got 4 plugs. But after a few months I felt drier (but still better that pre-plugs). When I lose a plug now, I go super-dry. Then when I get it replaced I feel great - for about a week. I think my eyes adjust to having a plug and then make fewer tears. I sure miss dripping tears!