Cautery vs Plugs

[Eyeproblems]

I did my 4th test of temp plugs today, since nobody in my city will do them, its a 2 hour drive for the 5 minute procedure. Anyway they helped, but my doctor only wanted to put the bottem in, because i started restasis. More out of his curiosity he wants to see if the restasis works, I just want relief and I know 4 plugs works, 2 plugs did not do enough. I learned that the previous 3 tests which he kept forgetting since its been 2 years.

Now he will do cautery but he kept pushing the plugs. The plugs have annoyed me in the past and i am pretty much set on the cautery. The plugs worked great for tears, but they itched.

His biggest concern was I may overflow with tears, he kept forgetting 2 years ago we went through a ton of tests and the only thing that helped was 4 plugs, yes their was slight overflowing at times, but it felt great. He seems to think it can be a problem.

1.Can anyone who has had catuery explain if tear overflow is a long term problem? And if it would be a huge unbearable issue (i cant see it being more unbearable then dry eyes) can you ever have it undone or altered?

2.Is there any reason not to do the cautery? Any people with experience with both can you chime in

I would just like to hear positive negatives of either, and which people prefer.

[willwork4tears]

Ahhhh....I've been through this battle and can help clarify a few things. First of all, check out a few of my older posts.

http://www.dryeyezone.com/talk/showthread.php?t=11995
http://www.dryeyezone.com/talk/showthread.php?t=12463

If you've been quadraplugged and were happy (not overflowing too much) then I think you'd be a good candidate for starting off with punctal cautery in the lowers only. I highly doubt you would overflow in that situation, if you're not overflowing with four plugs. Then if lower cautery isn't enough you can always do collagen (temp) plugs in the uppers. If it's too much then quit using the upper plugs.

My doctor claims that the epiphora (overtearing) is much more annoying than the original dry eye condition itself. I, also, find this terribly difficult to believe as I would rather dab at the eyes with tissue than be in chronic pain/discomfort. However, if you do experience epiphora and want to have the surgery reversed...it is reversible most of the time. But here's where the details come in. There are different types of surgical punctal ablation and some are easier to reverse than others. The punctal cautery, is not particularly easy to reverse. However, punctal ligation (where they cut the caniculus out and suture it shut) is more easily reversed. I believe I wrote some about these procedures in one of the previous threads I posted above.

If you feel like you would not overtear with cautery considering your experience with plugs...you're probably right. I had absolutely no concern that I would experience epiphora after cautery and I don't. On the rare occasion I have to dab or wipe at an eye I consider it a blessing. Also, I think you've been plugged enough (to know how you feel and want you want) and if you feel like you need a more permanent option then your doctor should consider that option with you.

I'm very happy with the cautery and don't regret it at all. If you do push forward with a surgical option...ask your doctor a lot of questions.

Which type of procedure do you do? Punctal cautery or ligation? How many have you performed? What's the long term success rate...i.e. how many patients do not experience spontaneous reopening?

For the cautery...what type of cautery do you perform? Thermal or laser?

If they spontaneously reopen will you repeat the procedure?


I hope this helps and feel free to private message me if you have more questions. Again, I think some of these things had been addressed in more detail in the previous posts.

[Guest]

1.Can anyone who has had catuery explain if tear overflow is a long term problem?

I'm sure individual results would vary widely on this depending on just how aqueous deficient one was to begin with... However, for myself, I don't mind one bit when I overflow... it is a HUGE improvement over the amount of discomfort I had pre-cautery/plugs (I have capped lower plugs and cautery for my uppers)

My right eye overflows regularly in the summer (maybe needs to be blotted once every 15 minutes or so)... my right eye sometimes overflows in winter (I think my eyes get more inflamed in winter, therefore less tears made and less overflow).

My left eye, on the other hand, is a pain in the a$$, and never, ever overflows.... it's a bummer... I wish it would overflow for once in its life!! Mind you, it could be worse... at least I no longer have constant discomfort/pain/burning anymore... if I'm careful with my eyes, I can usually be quite comfortable.

2.Is there any reason not to do the cautery? Any people with experience with both can you chime in

I would just like to hear positive negatives of either, and which people prefer.

If you think that it is likely that your eyes will dramatically improve in their tear-producing ability over time, then I suppose it couldn't hurt to wait a bit on cautery, and maybe stick with capped plugs that can be easily removed later on if needed. On the other hand, if you are confident that your eyes have healed as much as they ever will, and are still having a lot of dry eye issues, then for sure cautery is totally worth considering (assuming, as you've stated, that capped plugs are not comfortable for you)

I have capped plugs in my lowers (put in by my corneal doc), and cautery in my uppers. My lower puncta tolerate the plugs quite well, and I don't feel them at all... I've had them in since October 2010.... I've been fortunate in that they've never fallen out or moved etc.

My upper puncta point inwards towards my eyeball too much... so I've never had capped plugs in those... my corneal doc recommended cautery up there because he figured for sure plugs would irritate my eyes if put there. Since I think he is quite experienced/knowledgeable with plugs etc., I trusted his judgement on that and went along with it. No regrets.