Cautery - better option?

[SusieD]

I have been wondering this for some time now. Plugs help me in terms of moisture levels within my eyes and they definately feel better when I have them.

Trouble is, Ive not found a silicone one yet that I can tolerate (they always scratch my eyes when turning my head and end up having to come out). I have had one kind of intracannicular plug (form-fit) which was completely ineffective compared with the silicone ones. I have no idea if these are still in place or not. I am sensing not, because whenever I put any kind of drop in my eye, I can 'taste' it at the back of my throat a few seconds later so Im pretty sure things are draining through.

Anyway, the point is - I dont like these kind of plugs you cant see and keep an 'eye' on so to speak. Im NOT prepared to have anymore of these kind of plugs inserted. All I can do is keep trying silicone ones until I find one that is reasonably comfortable.

The other option is cautery - I realise this is classed as permanent, but to be honest I want a more permanent solution to this. I definately need some form of occlusion. If I just got the lower ones done first - Im not likely to have any over-tearing (have never had this, even when all four were temporarily plugged).

Do you think this would be an option for consideration considering the plug dilemma?. I also think from the perspective of a cash-strapped NHS, this would be a more effcient and economical option anyway, plugs are costly and extrusion rates are fairly high.

How many people on here have been cauterised? I know Diana has. what are the ups and downs - and would you still have it done knowing what you know?

[Rebecca Petris]

I think cautery is a very rational option if the need for long-term occlusion has been demonstrated. Haven't had it done myself as I don't have that specific need so I can't report any first-hand experience.

[neil0502]

I'm cauterized at all four corners.

Downside? For me: none. For some: epiphoria (too many tears), uncomfortable procedure.

Upside: if plugs work, you'll probably like cautery. No downside to trying the lowers, IMHO.

Good luck!

[SusieD]

Neil, did you have them cauterised after having plugs first? Is that when you noticed most of the improvement in your eyes - after you had it done? By the way, do you use restasis alongside this - (sorry cant remember if you said you did).

Thanks.

[neil0502]

I had plugs at all four corners for quite a while first. Unfortunately, a plug would occasionally fall out ... at the worst time ... like on a hiking trip in Colorado, so I went with cautery.

Didn't notice a lot of difference, honestly, but then, allegedly I'm not aqueous deficient, though I don't leak tears ... ever.

No restasis at the moment. Tried it twice, but with no results. May yet try it again.

[SusieD]

Its interesting that you have all four done and yet you (allegedly) don't have an aqueous problem (sorry if I read that wrong). I always thought it wasnt recommended unless aqueous deficiency was the main problem? Mind you, I have lipid problems as well as aqueous and plugs always make me feel more comfortable (well, apart from the last ones which were rubbish).

[neil0502]

Its interesting that you have all four done and yet you (allegedly) don't have an aqueous problem (sorry if I read that wrong). I always thought it wasnt recommended unless aqueous deficiency was the main problem?

Actually, I think you're exactly right, though the reduced corneal sensitivity does reduce my actual tear production under "normal" circumstances.

When the plugs and the cautery were done, I was going with the advice of the corneal specialist and the oculoplastic surgeon--neither of whom was a dry eye specialist, per se.

I had done so much research into my other primary eye issues (accommodative spasm and binocular dysfunction), and was working so many hours at my new job, that I didn't take the time to validate every single step and recommendation as it came to me. That said, because of the reduced corneal sensitivity, I don't believe that the cautery was, for me, a bad call.

Mine's a really complicated case (lots of things going on besides dry eye). YMMV. Doc's have had to "throw the kitchen sink at me" for years. I seem to defy all the conventional wisdom.

The short story is: cautery probably wasn't a "silver bullet" for me, AFAIK, but if plugs help you, then you may want to at least consider cautery as a more permanent, slightly more effective, and less potentially irritating (than plugs) option.

Best,
Neil

[SusieD]

Thanks, Im going to discuss it with the doctor next time I see him.

Can I just ask one more question? How long did the procedure take and was there much swelling afterwards?

Many thanks.

[neil0502]

Thanks, Im going to discuss it with the doctor next time I see him.

Best of luck, Susie!

Can I just ask one more question?

No limits here

How long did the procedure take and was there much swelling afterwards?

I had the thermal (not laser) cautery done (see below). The doc used a topical anesthetic (applied with a swab), then touched what looked like a pencil-type soldering iron to the puncta. I had the lowers done on one appointment, then the uppers on another--just to see how much effect the lowers had, and whether it was still indicated to cauterize the uppers.

Once I walked out of the office, I had ZERO pain, ZERO swelling. For me, it was an absolutely trouble-free procedure.

Obligatory links to voluminous garbage written primarily in (Pig) Latin:

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

[SusieD]

Wow - Im sold! (just need to get doc to agree!)

Seriously though - thanks for the info.

[indrep]

The down side to cautery is damages tissue that cannot be reversed without surgery. Also it opens back up in up to 50% of patients. Once cauterized you can not use the silicone plugs.

Just some things to think about.

[Danny_]

The down side to cautery is damages tissue that cannot be reversed without surgery. Also it opens back up in up to 50% of patients. Once cauterized you can not use the silicone plugs.

Just some things to think about.

I asked the doc today whether that was the case or not and she said it wasn't

[Flick]

SusieD - did you ever get your puncta cauterized? How are you doing?

[indrep]

Danny,
Which of the three statements did she say wasn't the case?

That cautery damages tissue. You are burning the tissue with cauterization.

That once it is burned together you can reverse it without surgery.

Cauterization reopens in 50% of the cases.

[SusieD]

SusieD - did you ever get your puncta cauterized? How are you doing?

HI - no I havent, in fact things are going much slower than I would like - or maybe I am just becoming more impatient! Not sure which!

The doc I see here is not at all for cautery in anyone who is under 60! So he may do it in another 32 years time!

Im just struggling along with the plugs etc at the moment, I still think cautery has a place though and if plugs continue to be problematic for me I would keep pursuing it.

Thanks for asking.