Cautery - hesitation

[Pat83]

Hi all !
I've been reading many of your posts for a while now but this is the first time I'm posting.
I've had Lasik surgery two years ago and ... hello dry eyes !
My symptoms are not as terrible as many of you (from what I read). Vision blurs, got to add tears or yawn every 30 mins, I feel like I have a grain of sand in my left eye... etc
Anyway, after noticing that artificial tears were not enough, I tried plugs, more plugs, different plugs. Eaglevision permanent plugs fell in or out, temporary dissolvable Visiplugs fell in (yes I started with permanent then moved to temporary, because the new doc said the temporary ones absorbed tears and should have therefore been more stable in the tear duct...), mushroom-type Painlessplugs kept hitting the eyeball and I couldn't look to my right without irritation...
The good news for me are, when plugs are in there, I feel great. The bad news are, the plugs mysteriously disappear after one week in the left eye (lost 5 plugs on the same side).
So now I'm thinking about cautery... but not only is the doctor hesitant and asking me to wait, but I also read your different posts and some people had terrible experiences with this.
In my case, it would be closing the left , bottom tear duct (because plugging only the bottom has proven to be comfortable enough); the doc says it's permanent and could cause problems if my tear production increases (would have overflow). But from what I've read here, I didn't see anyone saying their tear production has dramatically increased ? And some said the cauterization wasn't even permanent.....
Sorry for bothering you with this, but who could give better advice than people who have been in the same situation ^^
Thanks !!!

Pat

[patientpatrick]

Hey Pat.

I've been contemplating cautery myself. I'm 15 months post-lasik and I'm still struggling with dry eye. My schrimer scores pre-lasik were 18 and 19 and now they are 5 and 7. One doc i went to was hesitant to cauterize because he said my schrimer scores aren't that bad, and cautery could result in overflow. Personally I doubt it, because I'm quadra-plugged 2 silicone in my lowers and 2 extended duration in my uppers and I'm still dry. To be honest I'd love a little overflow myself.

Another doc I went to said he would never do cautery, because burning eyelid tissue can lead to a cascading effect of possible inflammation complications.

I have MGD and an aqueous deficiency and while i have noticed some relief with my plugs but not the overflow that some have experienced.

I also have the issue of always feeling the plug, like there's a grain of sand on the side of my eye, and I often feel that it's worse of an irritation than the dryness.

I don't know if this is exactly advice, since I haven't had cautery myself, have you had any luck with other treatments? What types of plugs have you used?

SAAG has recently found success with cautery, she's an awesome person to bounce thoughts off of.

P

[DCRdryeye]

I'm also tinkering with getting cautery since the DCR surgery left me with exceedinly large punctas, so no plugs fit. What I was doing is getting DuraPlugs inserted once a month, you can't feel them and they dissolve in about 1 month (although they claim 3 months). Yes, it's expensive and annoying to have it done once a month, if you can afford it....give it some thought.

[Pat83]

Thanks for your answers !
DCRdryeye: I'll ask my doctor about those plugs, thanks for the info
Patrick: Thanks for sharing what the docs told you, at least now I know what the risks are.
I tried a variety of plugs but the actual problem is that I have a very rare case: if I pinch my nose and blow, air comes out from the eyes.... Which means that every time I blow my nose hard, I have to take the back of a needle and push the plug back in !!! (The doc told me I was the first guy he met who was able to eject intracanicular plugs and bring them back in my hand lol). The plugs I'm talking about are the ones you can't see or feel. I couldn't stand the ones Patrick has which rub the eyeball. I guess the plugs DCRdryeye is talking about are quite resistant since they fit large punctas, but if those aren't possible the only solution I see is cautery :x

[DCRdryeye]

Pat, DuraPlugs expand with body heat and are supposed to cover your entire cannaliculus (that's where they insert them). You should not have air blow through your eyes when you hold your nose (does the air come out of the punctas? That's what happens to me on my left eye but was induced by surgery. It could be a structural defect you need to get looked at.