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I think my comparison of plugs and cautery could be helpful to those out there. I have severe post-LASIK dry eye and struggle daily (hourly!) as you probably do. If you're reading this, you probably know all the reasons why damming up those tears seemed necessary.
Early in my post-LASIK travels my LASIK surgeon put lower plugs in eyes. I don't recall noticing much change with this, and I soon talked him into plugging the uppers. This made a huge difference in the amount of tears in my eyes. I was very watery, though nowhere near comfortable. My eyes still had that "exposed" feeling. What's more, I burned. I swear I burned more this way. In addition, I could actually feel the protrusion of that plug rubbing on my sclera. Any time I moved my eye I was bothered by this. Occasionally, I would experience episodes of tears streaming all down my face.
Within two weeks one of the upper plugs fell out. I recall having an urge to call my doc to have something done...should I replace it or should I have the other one taken out. I actually walked around for an entire week with one plug in and one out trying to decide which felt better. It’s funny that my diagnosis was dry eye, yet with one eye dripping and one eye dryer, I couldn’t decide which I would rather have. The “drag” I felt from my lid on that drier eye was horrible. But the wet, salty one was horrible, too.
After a week of indecision, the other upper fell out. Now I was left with lowers. These I kept for many, many months until I had a reaction to a steroidal drop which forced one of the plugs out. I opted to have the other removed and honestly felt they weren’t doing me a bit of good anyway. I made an appointment with a dry eye specialist and decided he could help me with my next move.
Cautery was the next move.
The dry eye specialist I saw convinced me that cautery made sense in my condition. I did argue that while I was quadra-plugged, I had a ridiculous amount of tears, burning and bouts of tears streaming down my face. It was explained to me that those plugs (particularly the uppers) were a foreign body and my eyes would react as such. My excess tearing was reflex tearing caused by the feeling of the actual plug rubbing on my eye.
Looking back, my guess is that my LASIK doctor just didn’t know much about punctual plugs, nor did he suggest trying different types. I had no idea at that time that there were different kinds of plugs. Had I known, I may have “test driven” a few before giving up on them completely.
So, with the advice of my dry eye/corneal specialist, I decided cautery was the answer. We opted to do the lowers first and give it a few days to see if the uppers would even be necessary. I was not surprised that I felt no change in my comfort with the lowers done. He performed cautery on the uppers.
Fortunately, my result has been much better than plugs. I would agree that those upper plugs were, indeed, causing all sorts of nasty, uncomfortable tearing. Still, if a patient were to find plugs the he/she could not feel in the eye, it seems to me a reasonable option. Cautery is rather permanent. I don’t know exactly whether they can be “undone” successfully should I find I don’t want to be closed any longer.
I have also heard cauterized punctae can open after some time, especially if they’ve not been done properly. I’m pretty confident that mine were done properly, and will probably endure. It’s been well over a years since the procedure.
Regarding my comfort…
Although it’s not been ideal, I’m probably better off this way. I am still miserable and uncomfortable, and I struggle. I still feel my eyes are “exposed” and cannot tolerate any moving air or change in temperature. I’ve yet to find a manageable place.
Obviously, without the proper tear composition, it doesn’t make much difference how many tears we have coating our eyes. It’s simply not enough. I will add that at least having more fluid there is good for lubrication, but not for overall surface comfort. I actually met an eye doctor once who didn’t understand the difference between the two. Unfortunately, there is a huge difference.
Best of luck to anyone contemplating their next step. I hope this post has helped.
Early in my post-LASIK travels my LASIK surgeon put lower plugs in eyes. I don't recall noticing much change with this, and I soon talked him into plugging the uppers. This made a huge difference in the amount of tears in my eyes. I was very watery, though nowhere near comfortable. My eyes still had that "exposed" feeling. What's more, I burned. I swear I burned more this way. In addition, I could actually feel the protrusion of that plug rubbing on my sclera. Any time I moved my eye I was bothered by this. Occasionally, I would experience episodes of tears streaming all down my face.
Within two weeks one of the upper plugs fell out. I recall having an urge to call my doc to have something done...should I replace it or should I have the other one taken out. I actually walked around for an entire week with one plug in and one out trying to decide which felt better. It’s funny that my diagnosis was dry eye, yet with one eye dripping and one eye dryer, I couldn’t decide which I would rather have. The “drag” I felt from my lid on that drier eye was horrible. But the wet, salty one was horrible, too.
After a week of indecision, the other upper fell out. Now I was left with lowers. These I kept for many, many months until I had a reaction to a steroidal drop which forced one of the plugs out. I opted to have the other removed and honestly felt they weren’t doing me a bit of good anyway. I made an appointment with a dry eye specialist and decided he could help me with my next move.
Cautery was the next move.
The dry eye specialist I saw convinced me that cautery made sense in my condition. I did argue that while I was quadra-plugged, I had a ridiculous amount of tears, burning and bouts of tears streaming down my face. It was explained to me that those plugs (particularly the uppers) were a foreign body and my eyes would react as such. My excess tearing was reflex tearing caused by the feeling of the actual plug rubbing on my eye.
Looking back, my guess is that my LASIK doctor just didn’t know much about punctual plugs, nor did he suggest trying different types. I had no idea at that time that there were different kinds of plugs. Had I known, I may have “test driven” a few before giving up on them completely.
So, with the advice of my dry eye/corneal specialist, I decided cautery was the answer. We opted to do the lowers first and give it a few days to see if the uppers would even be necessary. I was not surprised that I felt no change in my comfort with the lowers done. He performed cautery on the uppers.
Fortunately, my result has been much better than plugs. I would agree that those upper plugs were, indeed, causing all sorts of nasty, uncomfortable tearing. Still, if a patient were to find plugs the he/she could not feel in the eye, it seems to me a reasonable option. Cautery is rather permanent. I don’t know exactly whether they can be “undone” successfully should I find I don’t want to be closed any longer.
I have also heard cauterized punctae can open after some time, especially if they’ve not been done properly. I’m pretty confident that mine were done properly, and will probably endure. It’s been well over a years since the procedure.
Regarding my comfort…
Although it’s not been ideal, I’m probably better off this way. I am still miserable and uncomfortable, and I struggle. I still feel my eyes are “exposed” and cannot tolerate any moving air or change in temperature. I’ve yet to find a manageable place.
Obviously, without the proper tear composition, it doesn’t make much difference how many tears we have coating our eyes. It’s simply not enough. I will add that at least having more fluid there is good for lubrication, but not for overall surface comfort. I actually met an eye doctor once who didn’t understand the difference between the two. Unfortunately, there is a huge difference.
Best of luck to anyone contemplating their next step. I hope this post has helped.
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