4 plugs so far no tears

[zuzu70]

I, too, am curious about the amount of occlusion achieved by collagen plugs, versus permanent ones, versus cautery. One doc said he'd put in a 30-day dissolvable (I understand it's a combination of collagen and synthetic). But I ended up seeing another doc for a 2nd opinion, and that doc said even if it's dissolvable he did not want to insert anything non-collagen, I think for the same reason smartplugs are risky. So, he put in a 7-day collagen plug. He did the top alone first and I really didn't notice much difference. Then he did the bottom and it was perfect for a day but I was dry the next morning. An hour after I got up, I felt something in my eye and rubbed the corner of my eye and a plug came out (he had stuffed two in there, so I'm not sure if the 2nd came out or not, so I still don't know how lower plugging would affect my morning dryeye which is my biggest problem). Unfortunately I was a victim of a punctal enlargement procedure so the permanent umbrella plugs won't fit me (and even if they would I'd be scared they'd fall IN rather than out since I don't have a nice tight punctal opening anymore). So, I'm assuming that cautery will be MORE occluding than these collagen plugs, but how much more?? I feel like it's the gamble of a lifetime for me. If collagen lowers were just right, does that mean cautery lowers would be too much? If collagen uppers didn't do enough, does that mean cautery of uppers would be just right?

[zuzu70]

I, too, am curious about the amount of occlusion achieved by collagen plugs, versus permanent ones, versus cautery. One doc said he'd put in a 30-day dissolvable (I understand it's a combination of collagen and synthetic). But I ended up seeing another doc for a 2nd opinion, and that doc said even if it's dissolvable he did not want to insert anything non-collagen, I think for the same reason smartplugs are risky. So, he put in a 7-day collagen plug. He did the top alone first and I really didn't notice much difference. Then he did the bottom and it was perfect for a day but I was dry the next morning. An hour after I got up, I felt something in my eye and rubbed the corner of my eye and a plug came out (he had stuffed two in there, so I'm not sure if the 2nd came out or not, so I still don't know how lower plugging would affect my morning dryeye which is my biggest problem). Unfortunately I was a victim of a punctal enlargement procedure so the permanent umbrella plugs won't fit me (and even if they would I'd be scared they'd fall IN rather than out since I don't have a nice tight punctal opening anymore). So, I'm assuming that cautery will be MORE occluding than these collagen plugs, but how much more?? I feel like it's the gamble of a lifetime for me. If collagen lowers were just right, does that mean cautery lowers would be too much? If collagen uppers didn't do enough, does that mean cautery of uppers would be just right?

Hey SAAG just wondering did you ever contact Dr latkany?

No... it seemed like a very expensive trip to me between the office visit, the airfare and hotel - from what I read on the forums, he sometimes suggests to give up all drops and see if things get better... other times he suggests allergy testing to rule out allergies as a contributing factor... he recommends the anti-inflammatory diet etc. I figured I could do all that on my own and save the cost of travel there. To me, despite how helpful I found his book to be, he likely does not have the magic bullet to fix this and even if one sees him, one will still have to slowly and patiently try to rule out stuff like allergies, giving up drops to see if one is merely sensitive to the eyedrops etc.

(I did actually give up drops for a couple of months back in 2009... didn't help... I was only able to give up drop for so long because I was on mat leave at the time and if my eyes got sore from lack of drops, I could keep them closed for an hour or so here and there... ice them lots... take care to never do anything that irritated them further etc.) And of course, the fact that giving up drops didn't help ME, doesn't mean it might not help YOU or someone else... no way of knowing unless you try...

As you know, I've found an anti-inflammatory diet of sorts to help - I say that since by giving up wheat, my diet is primarily vegies, fruits, nuts, cheese and lean meat - this is a very low carb way of eating and hence, is anti-inflammatory kind of by accident. I've also confirmed to my satisfaction that wheat, in particular, is a major problem for me when I eat it everyday. Question is: is it the so-called "anti-inflammatory" nature of this diet that helps? or is just the lack of wheat that has caused this diet to work for me? And again, just like with everything else, no way of knowing if such a change would help YOU unless you investigate and try...

In any case, I wouldn't pay the big bucks to see him unless I'd really and truly tried EVERYTHING else that he was likely to suggest and IF I felt he was likely to have some other suggestion for me that I couldn't come up with on my own. His book is quite excellent... but if you read through the forum posts from people who have gone to see him, it seems to me that for the most part, he put everything he had into the book (a good thing and awesome of him to do so!) and one could methodically try those things from home with the help of a local dr if need be.

Additionally, I think going to see him is tricky since a lot of suggestions involve try option A, then wait a couple of months to see if it works... if not, try B, then wait a couple of months to see if it works... etc. You can do that without flying out there. Plus, he won't even be able to check out your eyes each time to see what happened as he is limited to e-mail and/or phone contact with long distance patients after the initial visit (unless you want to spend the money of flying out AGAIN for another in-person visit.

...so I'm confused why all my friends who had lasik recovered in a matter of weeks while i'm still struggling to find relief. He states that nerves do recover to baseline after several years post lasik. I really do hope this is true.

Interestingly, my corneal nerves DID regrow properly (saw them myself from the confocal microscopy pics in Boston) - but as Dr. Rosenthal said, that doesn't mean they went back to FUNCTIONING properly once they regrew (there is no good way to test their function currently). I suppose we can look at LASIK as causing injury to those nerves... they won't necessarily function 100% for everyone after they regrow and supposedly "recover" from being severed in the LASIK procedure.

As to why that is the case with me (perhaps you also), and NOT the case with so many other happy post-LASIKS is definitely a mystery.

[soaps]

yep hopefullly i will recover with time. my plugs are comfy so will continue with them now. thanks for advice.

HI Soaps: Not sure if you were referring to my comment about my eyelid getting sore from the salt on my fingers or if there was something further up in this thread that caused you to ask but for sure the plugs don't irritate my eyes. Having said that, the very first plugs which I had inserted on the uppers (prior to the temporaries) felt like they were scratching my eyeballs like, I think it was Jenny who commented has happened to her. That is why I had the uppers cauterized. I might note that I don't hold out too much hope of making a full recovery as my primary problem is Sjogren's and so cautery didn't scare me. I sure wouldn't recommend it though until you are sure that you are not going to recover as it is permanent and you don't want to create another problem in the event that with time you recover....F/G

[soaps]

I'm so glad you like your plugs. What kind do you have? How long have you had them? Do you experience epiphora? I'm obsessed with that word right now because I want to experience it Hahahaha. It has seemed to bring such relief to those who've suffered so much

i have permenant umbrella on all four ducts. went straight onto them, they r very comfy now. some redness but this didn't change wen i took plugs out for a day. have had lower for umm 3 months and upper bout 2. no i never had epiphora. i do sometimes get extra tears wen i get anxious/upset but this is usually reflex tearing rsulting in redness. i wear moisture chambers 24/7 and tat helps.

[farmgirl]

When you guys say plugs irritated your eye. do you mean redness or pain?

HI Soaps: Not sure if you were referring to my comment about my eyelid getting sore from the salt on my fingers or if there was something further up in this thread that caused you to ask but for sure the plugs don't irritate my eyes. Having said that, the very first plugs which I had inserted on the uppers (prior to the temporaries) felt like they were scratching my eyeballs like, I think it was Jenny who commented has happened to her. That is why I had the uppers cauterized. I might note that I don't hold out too much hope of making a full recovery as my primary problem is Sjogren's and so cautery didn't scare me. I sure wouldn't recommend it though until you are sure that you are not going to recover as it is permanent and you don't want to create another problem in the event that with time you recover....F/G

[patientpatrick]

Hey SAAG just wondering did you ever contact Dr latkany? I'm tempted to head out to NY to see him but it's gonna be tough especially with a newborn. I read his book cover to cover several times. I luckily do not have any autoimmune diseases, so I'm confused why all my friends who had lasik recovered in a matter of weeks while i'm still struggling to find relief. He states that nerves do recover to baseline after several years post lasik. I really do hope this is true.

The last time I saw him he said that my dry eyes are still just mild and treatable. First off, it's not mild to me

I think what so many docs fail to recognize is the fact that although visible symptoms that they can SEE may be mild, our sense of discomfort may very well be severe... and no, it's not all in our heads and no, we are not hypochondriacs or just hard to please.

(I'm sure they run into people who really ARE exaggerating or hard to please... bummer that THOSE people make it tough for them to accept those of us who really and honestly ARE doing as badly as we say!)

I used to dream about all the wonderful things I could do w/o being dependent on glasses, and now all i dream about is for epiphora in my eyes. I can't believe that's how my life has ended up.

Yeah... life is just FULL of surprises isn't it. Too bad those surprises can't all be stuff like winning the lottery haha

[patientpatrick]

... but on the other hand, most people are back to normal 1 month after LASIK, let alone 1 year... decisions, decisions... will be interesting to see what your doctor thinks...

That's still what gets to me so much. I actually think that there must have been something wrong with me that either my Lasik surgeon didn't know about or just failed to tell me thinking it wouldn't be a big deal. The last time I saw him he said that my dry eyes are still just mild and treatable. First off, it's not mild to me second, it was never supposed to be treatable, it was SUPPOSED to be temporary, at least that's what I was told. Makes me so mad, that I could have prevented all this just by walking out the door.

I used to dream about all the wonderful things I could do w/o being dependent on glasses, and now all i dream about is for epiphora in my eyes. I can't believe that's how my life has ended up.

[jax8it]

It has been a year- Jan 21 was my anniversary. Yippee! not

I do think I need to give it a bit more time. Thanks for the suggestion though.

I have thought about it. Sometimes I think it would really help, just not sure yet....

I just noticed your siggy... I didn't realize you'd only had LASIK in 2012... I suppose given how recently you had it, it may be worth NOT doing cautery just yet, in case your eyes improve on their own still... tough to know what to do sometimes...

I had my cautery done in Jan 2010... a little over 4 years after my LASIK... not saying everyone should wait THAT long, as I was really suffering by then and it was pretty obvious that my eyes were NOT going to just heal up on their own by that point... but on the opposite end of the spectrum, less than a year out from LASIK may be too soon for something as permanent as cautery since you really and truly might still get a lot better without cautery... but on the other hand, most people are back to normal 1 month after LASIK, let alone 1 year... decisions, decisions... will be interesting to see what your doctor thinks...

EDIT - corrected a "little over 5 years" to a "little over 4 years"

[jax8it]

Upper right that got re-cauterized for the 3rd time 1st week of December is still holding strong! WHOO HOOOOOOOOOOO! Maybe the 3rd time was a charm? haha We'll see how long this lasts anyhow... will just enjoy it for now!



Jax9it, I though the exact same thing as Patrick... have you considered cautery? I know it must sound like an awful thing to get done, but I think most people (myself included) end up finding it not nearly as scary as it sounds...

I have thought about it. Sometimes I think it would really help, just not sure yet.... My new doc seems to think that a scleral for my left eye may help. He did not mention cautery at my last appointment and I forgot to mention it. I really need to take a notes to my appointments.

I am glad to hear this last cautery is helping!

[patientpatrick]

When you guys say plugs irritated your eye. do you mean redness or pain? And did you ever try removing and reinserting the same plugs but of course new ones ? I found this helped .
Can you undo a cauterization ( not sure if this is even a word)?

I like my plugs lol

I'm so glad you like your plugs. What kind do you have? How long have you had them? Do you experience epiphora? I'm obsessed with that word right now because I want to experience it Hahahaha. It has seemed to bring such relief to those who've suffered so much

Can you undo a cauterization ( not sure if this is even a word)?

Well, with cautery they are essentially burning your puncta shut - the resulting scarring of the puncta is what will hopefully block it off... for this reason, I'd consider cautery as a procedure that cannot be reversed. That being said, I'm sure there are surgeons out there who would be qualified to attempt to surgically re-open it (not sure what the success rates are for such procedures though)

[soaps]

When you guys say plugs irritated your eye. do you mean redness or pain? And did you ever try removing and reinserting the same plugs but of course new ones ? I found this helped .
Can you undo a cauterization ( not sure if this is even a word)?

I like my plugs lol