Need Advice! 4X Cautery/ Emotional wreck

[Jasper]

Hi All,

Yesterday I went to the eye doc for a weekly visit and he has decided it is best to close all 4 puncta by cautery. He made this determination after repeating another Schirmer test which I knew would be completely dry 0,0 both eyes. We already did a tear test a month ago, not with Schirmer paper though, I'm not sure what it was to be honest. Anyways, 3 serial tests 0,0 each time. (Those paper strips are EVIL and the next doctor that tries to put one in my eye is going to lose a finger.)

I'm hesitant to have the cautery done for the following two reasons:

1. There is absolutely no moisture in my eyes ... When I lift the upper lid it sticks to my eyeball!! What good will closing all the drains do if I don't have any tears to begin with? Now lets see, if I plug up a sink and never turn the water on I wonder how long I'll be waiting for it to fill up. Hmmmmm ... it just doesn't make any sense.

2. I want to try scleral lenses at some point and I'm afraid that having the cautery done will keep me from having a successful outcome. Has anyone here tried sclerals with 4 puncta closed?

When I first found out how serious my condition was, and how limited my treatment options were, I fell into deep depression. With the help of my counselor and dry eye talk I was able to put my head back on straight. I had a new attitude and a smile on my face. Went from crying all the time to not crying at all ... actually started to look forward to things again.

Unfortunately things have changed quite recently as it seems the few options available have run out. Is this really all there is? Just buy a lifetime supply of Systane and hope for the best? Plug up all my tear drains to keep the imaginary tears on my eyes? I'm back to crying everyday and thinking about how my future doesn't exist anymore. I have to get out of this mindset but I don't know how. I don't care if my eyes are red, I just want to be FUNCTIONAL so I can help provide for my family. How do I make myself strong again? Someone please help me.

[calli66]

I tried plugs X4, and it didn't turn out well because of your Reason #1 (sort of). My Schirmers is 2-2. But I got a lot more inflammation because of the "plugged drains." Did your doctor try the plugs already? If not, I think that's a more conservative approach than going straight to cautery.

What else have you tried? Moisture chamber glasses? Restasis? Anti-inflammatory meds? Autologous drops?

Have you tried Dwelle (the drops sold in the Dry Eye Shop) here? Read the description by Rebecca Petris---especially the "What if I don't like it at first?" part.

This may be hard to believe, but things will get better. And maybe cautery and schlerals will be part of that.

Stay strong.

C

[Rebecca Petris]

I think lots of scleral wearers have plugs and/or cautery. But to address any questions or doubts you could get the definitive answers from Brenda Diaz at BFS at 781.726.7337.

The one procedure I know is a real no-no before BSLs is tarsorrhaphy as it would have to be reversed.

There are a lot of people with 0 Schirmer and "no moisture" who still benefit from plugs or cautery. Hard to tell... these things are very individual.

Are you wearing moisture chambers currently?

The emotional part is so hard. I can imagine it must be discouraging to have come through it once and be back there again but everything that's true in one spike of depression is true in another: It's so hard to be there, but it will get better as you get new treatments and adjust to the latest 'downturn', and meantime it sounds like you're doing all the right things to position yourself for it to get better sooner.

I just went back to look at your other posts. Considering where all you have been with this and where you're at now I really would encourage you to go ahead and contact Brenda to start talking through the BFS option and what it would be like.

[Guest]

re: cautery helping if there are no tears to begin with...

I think there is still a potential benefit... it will keep any artificial tears you apply in there longer since they can't drain out.

[Jasper]

calli66 - I totally forgot about Autologous drops ... my doctor makes them at his office so I'll ask first thing when I see him next. I have already had plugs which didn't help - they have since been irrigated out. Now only my left lower punctum is cauterized. Moisture chambers are next on my list - I want some like SAAG has for work as I sit in front of a computer all day. Not sure where to start with that though? I've asked a few opticians around here and most don't have any idea about moisture chambers. I think I'll get some onion goggles to hold me over ... they will at least keep me comfortable at home. I'm scared to try any drops with a preservative ... not sure what Dwelle has in it so I'll check the review.

Rebecca - I think I will call BFS soon. I just had the AMT surgery so it might be awhile until I have any funds available again. Have to wait on the insurance company ... My doctor doesn't really want to talk about sclerals and I don't know why??


Thanks everyone for your kind words and advice.

[hirentherock]

i HAVE HAD CAUTERY DONE(for both eyes) WITH MY AMT SURGERY(for 1 eye) BEFORE 2 YEARS.

Everything went well for the next 1.5 years...again im starting to have irritation n pain.And dryness in both eyes increased.

I think my cauttery has again opened up.So im planning to get it done again.Lets hope again i will be in the painless soothing state after that

[Rebecca Petris]

Moisture chambers are next on my list - I want some like SAAG has for work as I sit in front of a computer all day. Not sure where to start with that though? I've asked a few opticians around here and most don't have any idea about moisture chambers. I think I'll get some onion goggles to hold me over ... they will at least keep me comfortable at home.

Onion goggles are a good idea and any time spent in a moisture chamber is good but computer time is probably the most critical.

Do you need Rx?

Simplest office solution is MEGs. Expensive but good. For custom moisture chambers, you might try calling EagleVision at 800.222.7584 and ask them which (if any) opticians in your area fit their moisture chamber material - called 'moist eye moisture panel'.

Other option is Wiley/7Eye wrap sunglasses, with clear or light-adjusting lenses. Very effective, but cosmetically not so hot for office environment.

[dryasadesert]

You should DEFINITELY try 4 punctal plugs first....they can be removed easily so it is reversible. there is no reason why a doctor should recommend cautery over plugs first. I tried 4 plugs and it made my eyes worse because I was circulating crappy tears.

Cautery is very hard to reverse. If you didn't benefit from 4 plugs, it is highly doubtful you would benefit from cautery.

[indrep]

Jasper,
You could be making a minute amount of tears. Depending if anesthesia was used for your schirmers the result might not be showing this tiny amount. I would go with plugs first before cautery.

My wife tested a 0,1 with schirmers and was using 14-16 drops a day of a preservative free tear. She was quadra-plugged and started Oasis TEARS Plus two years ago. She now gets through a day on only 1-2 drops a day. there are still some bad days of course.

[Jasper]

Well, I've made the decision not to do the cautery right now. It just doesn't feel right and like some of you mentioned I can always try plugs. My left punctum is already cauterized (forgot to mention this in my first post) and I love it .. I don't have to worry about things like you do with plugs ... but I'm not ready to have the uppers done. My right lower is still open due to an infection and surgeries ... the eye just hasn't been healthy enough until now.

Thank you everyone for your responses and support. I can't put into words how much dry eye talk has helped me.