Advice wanted re breeze sensation and occlusion

[zuzu70]

I didn't get any responses to my original post; I hope it's not because I have offended anyone or that I've come off sounding like an idiot. I'm trying a repost; hope this is not against policy.

I'm looking for advice. When I had temporary collagen plug inserted in the upper punctum, it only helped a tiny bit, although I did wake up the next morning without morning dryness. When I had the temporary inserted in the lower punctum, things felt much better and still no epiphora. But I understand that cautery closes things up more completely than temporary plugs. So, do I have the doctor cauterize the lower since that's the one that felt better to me? Or do I have him cauterize the upper, since cautery closes things up more fully than temporary plugs and thus the effect would be magnified compared to the plugs? I don't have severe severe dry eye (TBUT of 5 and Shirmer's is 4). At this point the docs just tell me it's up to me to say when and where. What's your advice, folks?

Another aspect I have to consider is that my upper lid has a small crater-like notch in it, essentially where the doctor cut away the tissue on one side of my punctum last year. I almost constantly feel a breeze in that crater. It's especially uncomfortable if I open my eye wide, so oftentimes if I'm walking down the hall or doing something else that creates a breeze, I half-close my eyes or look down. I don't know how much of that breeze sensation is just the upper eyeball being dry, versus the breeze actually getting up there in my punctum. On one hand, sealing off that upper punctum might alleviate the breeze sensation; on the other hand, cautery may cause the crater to get slightly bigger leading to more exposed eyeball making things worse. Whenever I've asked a doctor about this, I get pegged as an "over-analyzer" and not taken seriously by them.

On the bright side, my left eye is perfectly good, so any overwatering won't cause too much blurry vision. The downside is that my eyes don't feel symmetrical (one dry, one nicely moist) and that bothers me a lot.

[indrep]

My thoughts would be to try the longer duration temporary plugs first. If sized properly they do indeed occlude the canaliculus (the drain pipe) 100%. I am not a big fan of changing the tissue through cautery when there other alternatives to try. Once tissue is altered it makes other less invasive options difficult or impossible to use.

As for the breeze when walking there are wrap around glasses that greatly reduce air flow across the ocular surface.

[soaps]

Yep try permanent umbrella plugs first easily removed if required. don't let permanent name fool u. then perhaps consider cautery .
They were initially uncomfortable for me then removed and new Reinserted - perfect fit ! Im glad i tried again rather than cautery.

[zuzu70]

Thanks, indrep. I'm having trouble finding wraparound glasses that work with my prescription (-4.00). I found a pair (just regular Coppertone sunglasses) that fit my face *perfectly* the other day, but the optician told me they wouldn't work with my prescription because they don't make blanks that are that curved. I was so bummed, because it was like they were *made* for my face, and they said "prescriptionable" on them, but apparently not. I loved them, though, because they sealed entirely against my face without being goggley and without foams. If I could get a fit like them I'd happily get ones in both sunglass and regular, or maybe transitions. I'm currently wearing a pair of sunglasses that are way too big on my face and say "Daddy-O" on them -- they're men's -- because that's the best seal I could find in a prescription.

I don't think umbrella plugs would be safe for me, soaps, since I've had the punctal sphincter cut away and I'm afraid they would slip down into the canaliculus and get stuck in my nose. As soon as I get the courage I will go back to the mean optometrist who mocked me and ask for the longer duration temporary plugs he suggested months ago.

[Rebecca Petris]

zuzu70, try the Wiley X AirRage. See wileyx.com for a dealer locator. That frame if I remember right goes up to -6 sph. I'm wearing that type right now myself... funny I always thought AirRage would be too small for me but I was hunting around amongst my returns for something when I lost my old sunglasses recently, couldn't find anything with dark enough lenses for my needs except an AirRage so I tried it on and it actually fit perfectly. - Over the years though I've found AirRage to be the style that fits more women than most others especially women who need a smallish to medium size.

[Rebecca Petris]

p.s. I wonder if the breeze thing you're talking about is what Rojzen so aptly dubbed the "menthol sensation", a term a lot of our members have found helpful to describe a feeling of cold or moving air on the eye.

[zuzu70]

Yes, I guess you could call it a menthol sensation. I feel the "breeze" in two different ways. Firstly, the whole eye surface feels exposed, and I can feel any tiny bit of moving air on it, and yes, the eyeball feels cold compared to my good eye. Secondly, I have a small craterlike notch of my upper lid missing, where the doctor removed tissue around the punctum. When there is moving air, I particularly feel it in that upper-lid notch. (The lower punctum was cut away too, but that notch is sheltered against my eyeball.) Interestingly, a few years ago a doctor temporarily dilated my lower punctum, and for a day afterward I felt a breeze in the (dilated) lower punctum. So I think it's two separate issues: dry eye menthol sensation, and a gaping-wide punctum.

I had one doctor tell me that the extended duration temporary plugs were dangerous. He was not talking about a Smartplug, but like a Duraplug or Oasis Extended Duration or something of that nature. Is there any truth to that?