Punctal Cautery

[LaDiva]

I've decided to have punctal cautery next week, and am wondering if those of you who have had this and also have MGD have had problems with the "cesspool" effect. Plugs really bothered me, and so cautery has been recommended by several doctors. Also, I've got to go to work the next day, and am wondering if I'll feel OK. Thanks.

[BigNate]

If you have MGD, will cautery be any better than punctal plugs? I don't understand how this would be a solution to being lipid deficient.

I've decided to have punctal cautery next week, and am wondering if those of you who have had this and also have MGD have had problems with the "cesspool" effect. Plugs really bothered me, and so cautery has been recommended by several doctors. Also, I've got to go to work the next day, and am wondering if I'll feel OK. Thanks.

[LaDiva]

Hi Big Nate,
The plugs drive me nuts. I've tried them more than once. They rub against my eyeballs every time I move my eyes. I have aqueous deficiency, MGD and Ocular Rosacea. A real combo- pack, requiring just about every treatment known to mankind. Not enough water, not enough oil and an auto-refill of inflammation.

[LaDiva]

I've decided to try plugs again.I refuse to give up hope that things will improve and keep thinking about the song "Yellow Taxi". You don't know what you've got 'til it's gone.

[patientpatrick]

hey ladiva. how is your experience or should i say re-experience with plugs? are you quad-plugged? I recently got quad-plugged but with temps. I think maybe i noticed a marginal increase in tears. truthfully i was hoping for some epiphora that so many have said they experienced by being plugged in all 4 ducts

[LaDiva]

Hi Patrick!
Just got them put in the bottom drain pipes this afternoon. I've been plug-free for about a year and a half due to "fall out". Well, the exciting thing is that when I do a warm compress and expression, my eyes feel wonderful; just like they did when they were healthy eyes. The not so exciting news is that the plugs still rub against my eyeballs, and I feel like there is something in both eyes. (I guess there is!) I am going to give them a few months and see how it goes. My hormones are being balanced, and the vitamin regimin hasn't had enough time to fully kick in yet, but I should see results if they are to happen by the end of March. If I am still dry-eyed by June I will go for cautery. I will tell you that it really helps to have more fluid rolling around. The doc is going to re-assess in March and decide whether to plug the top or not. Never had the temps, so I don't know anything about them. You've got to have enough oil and tears to smooth the whole mess out. Maybe you don't have enough oil either?

[patientpatrick]

Hi Patrick!
Just got them put in the bottom drain pipes this afternoon. I've been plug-free for about a year and a half due to "fall out". Well, the exciting thing is that when I do a warm compress and expression, my eyes feel wonderful; just like they did when they were healthy eyes. The not so exciting news is that the plugs still rub against my eyeballs, and I feel like there is something in both eyes. (I guess there is!) I am going to give them a few months and see how it goes. My hormones are being balanced, and the vitamin regimin hasn't had enough time to fully kick in yet, but I should see results if they are to happen by the end of March. If I am still dry-eyed by June I will go for cautery. I will tell you that it really helps to have more fluid rolling around. The doc is going to re-assess in March and decide whether to plug the top or not. Never had the temps, so I don't know anything about them. You've got to have enough oil and tears to smooth the whole mess out. Maybe you don't have enough oil either?

Hey Ladiva. Why did you go for so long w/o plugs? I'm glad they are bringing you relief. Seems like they were long overdo or re-do. What type of plugs did you get? did plugs always scratch your eyeballs? perhaps there's a different type of plug you could try. Did you ever have uppers done as well? I'm thinking about cautery too, but I'm scared of it. How long ago did you have Lasik? I have an aquaeous and oil deficiency - Lasik induced of course. I'm 14 months post op and have heard very conflicting things from the eye doctors I've seen and heard from on forums. Some say I'll improve and get back to pre-lasik and others saying its permanent and where i'm at is about as good as it will get. Lack of hope is depressing, and as farm as i'm concerned false hope is even more so.

[LaDiva]

Hi Patrick,
The first two sets of plugs didn't help much. I can only guess that it was because my eyes were in much worse shape a couple of years ago. I don't know what kind of plug the doctor put in yesterday. They are permanent plugs, and feel pretty much like the other plugs; like rocks. My lipid layer is better than it was, although still not great. Never had the uppers done, but the doctor is going to re-assess that possibility in a couple of months. I had PRK six years ago. Severe dry eye hit two years and eight months ago. I've had dry eye since 1992, but very slight. If my eyes aren't better by June, I am going for cautery, because the plugs do help, they are just very uncomfortable. I think there is a good chance you will improve. It took at least two years after PRK for me to be able to say my eyes felt healed, but then PRK has a longer recovery and healing time. I don't think your eyes are fully healed yet. I understand what you say about having hope. That is really what it is all about. Hope and faith. Both big, big things. Hang in there. I have gotten much better, but not well yet. I've been through filaments, photophobia, infections, styes, terrible pain, you name it. Just got to keep on top of the eye-care routine like a drill sargeant, and try to stay calm, have faith and be hopeful. Pretty big shopping list!

[patientpatrick]

Thanks for the reply LaDiva, what have you done to improve your lipid layer? I find it interesting how severe dry eye hit you over 3 years after PRK even after you healed. Do you think your sever dry eye was caused by something other than PRK, or did PRK send you into a worse state? I keep hearing that PRK is better for people who have dry eyes since there are less nerves that are cut. I read Dr. Latkany's book and he states that PRK nerves heal a year earlier than Lasik. I guess I don't know what to believe anymore. Hope for me is a tricky thing, because i don't know how to keep the faith so to speak.

[LaDiva]

Hello Patrick,
I had IPL about a year and a half ago. It brought my TBUT from 3 to 7 seconds. Helpful, but still not enough to be comfortable. I've kept working on the oil with hot compresses, expression, TheraTears Nutrition, EFA and diet. I use Dr. Latkany's spa treatment, and Rebecca's rice baggie! Not sure about PRK and recovery, but know my eyes didn't work very well until two years post op. My doctor told me before the surgery that PRK had a longer recovery time than Lasik, but maybe he was talking about time home from work as opposed to actual nerve regeneration. Not sure about that one. I am sure you will feel better Patrick. It just takes an really long time for some of us, and I have been one. The plugs really are helping now!

[farmgirl]

Hi La Diva: I first had plugs on the uppers that felt like they were scratching my eyeballs and I hated them. I then tried temporaries that were inserted into the duct but dissolved in 3 weeks. Those helped a lot so I bit the bullet and had the uppers cauterized. I don't advise going to work after. Some people seem to think it was a cake walk but for me I looked like I had gone a couple of rounds with Mohammed Ali (and lost) for at least a week. I will say that mine never did reopen as so many have so I guess that was a plus. So far I have no regrets...cheers...F/G

[LaDiva]

Farmgirl! I won't mess with you! Mohammed Ali, huh? LOL Thanks for the info. I was wondering about down-time. I talked with one of the girls who works in the eye doctor's office and she said she had hers done and was very happy. She said her eyes feel almost normal, and she even wears contacts again. I am amazed how much better my eyes feel, and how few drops I've needed today. Strange how something doesn't help and then things change and a year or so later it does! I guess Tankie discovered the same thing. Awesome! Have a great weekend.

[patientpatrick]

I may look into Cautery. I suppose i should try the permanent plugs first. What I'm still confused about is the fact that I was quadra-plugged with collagen plugs and experienced zero epiphora and I'm still dry. I've been told there that there is a difference between silicone and collagen in terms of occlussion so I'm hoping I'll get a chance to experience some overflow of tears. 14 months post-lasik leaves me with a lot of well, unanswers so to speak. If I felt like this perhaps 6 months post-op I could chalk it up to healing still, but over a year.... could be permanent still hoping its not, but then again its hard to believe. Thanks for posting LaDiva and farmgirl.

[farmgirl]

No worries, I lost remember. I could have gone to work, if I actually had a job and worn dark glasses. There was no real pain, just a lot of ugly bruising and swelling. I remember coming into my husbands office (he works at home) and reminding him that he married me for better or for worse and this was definitely on the 'for worse' side. We had a good laugh. I did go on a vintage car tour that weekend but hid behind my dark Wileys. I was not impressed with the Dr. office though who assured me it would be business as usual, NOT!

[LaDiva]

Farmgirl, what do you think caused the bruising? Good for you for going on the car tour!