Even cauterized tear ducts isn't working!!

[Leann93]

I will take any advice I can get. I have had dry eyes for 2 years which came on suddenly. I have had my blood checked for many things more than once and all are good. After many medications,steroids, plugs, Goggles, etc. and many doctors I had all four tear ducts Cauterized. It worked for 2 months and now back to day one. Burning all the time and inflamed. I am a healthy 38 yr old woman. 4 Doctors and none of them know what to do. They have all said they don't know why nothing is working. But for 2 months after the surgery I felt good. Very little tearing and no burning for 2 months. Can anyone relate and offer some advice please..

[Guest]

I'm having a similar issue with my left eye... had the cautery re-done and it was wonderful for 5 weeks... then overnight it went dry as a bone and has stayed that way... it's frustrating... the left used to be my good eye...

I feel like if it was swelling from the cautery causing reflex tearing or whatever for those 5 weeks, surely it wouldn't stay steady with lots of tears for 5 weeks and all of a sudden go to no tears literally overnight?? Doesn't the overnight change make it seem more likely that the cautery just re-opened? If the lack of tears was due to the absence of the post-cautery swelling/reflex tearing, would this decrease in tears not have happened more gradually over the healing period?

Will ask my doc again when I see him in Jan... don't feel like making another appointment sooner... tired of dr. appointments...

Will be interested to see what replies you get Leann...

[MaryVa61]

Was there anything at all different about your routine at home for the month or two after surgery? I can't imagine what the problem is unless you, like me, have an undiagnosed skin allergy that is affecting the eyes and inner lids rather than actual skin. My wierd patterns of worsening & improving ended up being caused by my formaldehyde allergy and changes in my routine that caused or eliminated exposure. My latest flare-up of pain and dryness was caused by a throw pillow on my sofa, which I had to throw out. Formaldehyde is very often used as a fabric treatment. If there is any chance of skin allergy, they can't tell with blood tests or exams. And reactions are delayed by 1-4 days so you can't figure it out either. It requires skin patch tests by a dermatologist or a great allergist.

Just a thought. Prior to diagnosis my ophth talked about doing cauterization surgery but another recommended we wait.

Mary in VA

[djb]

My cauterized ducts opened several times....been cauterized multiple times....have a feeling that one or more ducts have reopened in your case.....please have a doctor test them to see if they are open or not.....if the doctor looks at them and says they are closed and doesn't test them....go to another doctor who is willing to test them and not just look at them. Some doctors are afraid to touch previously cauterized ducts. My doctors would shoot saline or tap water into the punctum and if they were open I would taste the fluid in the back of my mouth. Hope this helps you.

[dryeyes4ever]

Even cauterized tear ducts isn't working!!

I think it's just the nature of the beast that is dry eyes. I've had dry eyes my entire life & had all 4 tear ducts cauterized over 20 years ago. I had to have them re-done 10 years ago b/c they had re-opened. They are still closed now. There was definite improvement right after both procedures, but over time, your eyes will go back to "normal"; unfortunately it's not a cure-all.

I've been seeing a dry eye specialist for almost a year now & he's had me on Azasite on and off for many months, getting the glands in my lower lids to open (my left eye is much worse than the right). He said this will be my life from now on unless there is a cure someday. He said patients become very good friends w/their dry eye drs b/c of all the visits. I'll have to use the Azasite every 6 months or so to re-open my glands. I'll have a few good days & then a few bad days. I find what makes the biggest difference is the amount of sleep I get.

Until there's a cure, we just have to manage our dry eyes as best we can & try & live a productive life! Hang in there!

[Guest]

I think it's just the nature of the beast that is dry eyes. I've had dry eyes my entire life & had all 4 tear ducts cauterized over 20 years ago. I had to have them re-done 10 years ago b/c they had re-opened. They are still closed now. There was definite improvement right after both procedures, but over time, your eyes will go back to "normal"; unfortunately it's not a cure-all.

Just wanted to say that I don't think they always go back to "normal"... my right eye was also cauterized - that eye has stayed drippy, and it's been almost 2 years since cautery (prior to cautery it was bone dry). (Mind you, that's nothing compared to the 20 yrs you've been dealing with this)

That being said, how long do you find it takes before your eyes go back to "normal" after having your puncta cauterized?

[Hopeful2]

SAAG,

Isn't there an easy test for an open duct? I would think that if you had a doctor put a coloured dye in only the left eye, then if the dye shows up in your nose, you can conlude that the duct is patent. I know what you mean about being tired of going to doctors, but waiting till January is a long wait.

I see my eye doc tomorrow and will probably be getting plugs.

Take care,
Hopeful2

[Guest]

I know... January IS far away... but I've been to the various doctors sooo many times in the last few years, lab every 3 mo. for serum, and on it goes... I'm just tired of it all... I just want a break. If I had a crystal ball haha, and it said for SURE the doc would decide that my left upper puncta is open and proceed to re-cauterize it right away, then I'd go asap... but without such a guarantee, I don't feel like bothering I don't know... maybe I'm being foolish.. but it was such a let down last time to have him think it's open...

I left my last appt. wondering "did he really seriously consider the fact that the moisture level/drippiness was almost constant for that full 5 weeks and literally went dry overnight?? Did he think maybe that I was remembering incorrectly and THAT's why he's leaning towards thinking it's prob. still shut?"

Anyhow, he noticed that the MG's in the left eye were looking really bad at that appointment, so he gave me Tobradex (antibiotic + steroid) drops to use twice daily for a week - they totally cleared up the glands and they looked great again (that's me thinking that based on what I can see with my 20x LED light magnifying mirror). Drops lasted longer in that eye once again with the MG's not so clogged, but it still is basically dry as a bone. He prob. thought that eye was just feeling so dry due to the MG's being flared up... but from what I could see with my mirror, the glands had been looking good by the end of the 5 weeks post-cautery - when it seemed to re-open, the glands in that eye got worse and worse over the following 2 weeks leading up to the appt. with him - my theory is the dryness flared up the glands - his theory (I think) that the glands caused the eye to feel dry (ie. rather than the puncta re-opening)

Soooo... maybe I should go back... then he can see that even with the glands looking better, the eye still feels bone dry to me... he'd prob. look into the possibility of the eye being dry due to a potential opening up of the cautery... but who knows for sure right?

argh... frustrating not knowing for sure what the problem is... I'm still leaning towards thinking it's dry because the puncta is open... but what if I'm wrong? then I'm wasting my time going back for another appt...


As for the dye thing, that certainly sounds like a good thought... my doc had only mentioned irrigation as a means to test it, but said that the irrigation itself can open up the duct... wonder how well the dye thing works in comparison... (at least the dye can't re-open it)

[DCRdryeye]

I have resisted getting my ducts cauterized. However, my consulting eye doc at the time said the ducts will remain permanently closed with her technique. She cauterizes and then sews the puncta's closed over the top. I believe it involves general anaesthesia.

[dryeyes4ever]

Just wanted to say that I don't think they always go back to "normal"... my right eye was also cauterized - that eye has stayed drippy, and it's been almost 2 years since cautery (prior to cautery it was bone dry). (Mind you, that's nothing compared to the 20 yrs you've been dealing with this)

That being said, how long do you find it takes before your eyes go back to "normal" after having your puncta cauterized?

After cautery, both eyes would tear a lot, to the point tears would run out of my eyes. This would last a few days & w/in a week, they'd feel about the same as they did before the cautery.

I've had 2 REALLY bad days. The rims of my eye lids feel raw; very painful. I emailed my eye dr. to see if there is any type of numbing eye drop to help w/the pain. The whole dry eye issue just really sucks!!!

[Leann93]

Was there anything at all different about your routine at home for the month or two after surgery? I can't imagine what the problem is unless you, like me, have an undiagnosed skin allergy that is affecting the eyes and inner lids rather than actual skin. My wierd patterns of worsening & improving ended up being caused by my formaldehyde allergy and changes in my routine that caused or eliminated exposure. My latest flare-up of pain and dryness was caused by a throw pillow on my sofa, which I had to throw out. Formaldehyde is very often used as a fabric treatment. If there is any chance of skin allergy, they can't tell with blood tests or exams. And reactions are delayed by 1-4 days so you can't figure it out either. It requires skin patch tests by a dermatologist or a great allergist.

Just a thought. Prior to diagnosis my ophth talked about doing cauterization surgery but another recommended we wait.

Mary in VA

Haven't done the skin test, thanks for the advice

[Leann93]

I was recommended to try a procedure where the doctor uses my blood to make tears. Has anyone tried this?

[spmcc]

I was recommended to try a procedure where the doctor uses my blood to make tears. Has anyone tried this?

They're called autologous serum drops. Search for the term "serum" here on DEZ. There are lots of people using them. Good luck.

[DCRdryeye]

After cautery, both eyes would tear a lot, to the point tears would run out of my eyes. This would last a few days & w/in a week, they'd feel about the same as they did before the cautery.

I've had 2 REALLY bad days. The rims of my eye lids feel raw; very painful. I emailed my eye dr. to see if there is any type of numbing eye drop to help w/the pain. The whole dry eye issue just really sucks!!!

These are amongst the reasons I've personally refused to have my own ducts cauterized. If excessive dripping is occuring for you, I'm wondering if there is a surgeon smart enough to create a tunnel or a small hole through where the cauterized duct is to allow some tears to drain through. Perhaps make a list of occuloplastic surgeons and call them all, leaving the question with them. It will save on consultations.