Cautery Anyone?

[np1981]

Is there anyone here who can share their experiences with thermal cautery?

The 4 plugs in my eyes are helping a lot, but occasionally they have been
displaced and one has required replacement twice in the past few months. I
wish to explore a more robust solution, especially as it is necessary for me
to have my puncta blocked permanently.

I am considering getting my two lower puncta cauterised, as I don't fancy
any of the other types of plugs (I currently have the sillicone "capped"
plugs). I understand that this procedure is not reversible.

1) How effective is cautery in blocking the puncta?
2) What is the procedure like (pain, discomfort etc.)?
3) What are the potential complications?

My experiances with UK doctors is that they are not too keen on performing
it because I am "only 25". That's why I don't want all 4 cauterised, but I
do want at least the 2 bottom ones.

Nik

[SusieD]

This is how I feel Nik, If you benefit from having all four plugged and you dont get overflow problems, I can see no problems with cauterising the lower ones at least. You can always keep the plugs in the uppers for now.

Has Dr Tseng not mentioned doing this?

As for finding a doctor who will do it in the UK - might involve a lot of searching!

I totally understand your position though.

[np1981]

Cautery was mentioned once by Dr Tseng - but he simply mentioned it in passing, when I complained about the lower left plug problems I was having. If cautery means I dont have to worry about plugs, I want to do it.

[Silverlady]

Me too!

Nik,
I have lower punctum cauterized and have not regretted it. Pain was very minimal and lasted only a few seconds. Eyes were a tiny bit swollen for a couple of days, not bad at all. My opthalmologist told me that he might have to "touch up" if it opened up after the first try. I did have to have one "touched up" but the other one was fine. Not sure about the potential complications as I had no choice.

Billye

[np1981]

Thanks, thats everything I wanted to know.

[SusieD]

Are you looking into getting this done then?

[np1981]

Yeah, I think I will. Just the lower two. Though finding a doctor in the UK willing to do this seems strangely difficult. My local doctor looked at my age and told me I'm too young (25). He calimed they only consider it when older, and only for younger people if really necessary. I think mine are necessary!

[Guest]

np1981

I can understand their reluctance due to your age (25). I am 37 and they won't hear of it for me either, however my situation is different as they believe that my laser induced DES is improving so it would be a counter productive procedure and I could end up with overflow.

At this point, I am functioning on bottom plugs only and seem to be getting through my days OK, nights are still a challenge.

I think it is a difficult call as the results should be viewed as permanent and irreversible. I guess the challenge you now face is convincing the appropriate medical staff that it is the right outcome for you.

Regards

Ian

[np1981]

Hi Ian.

I sort of understand their concerns, but at the moment I have 4 plugs. I am only looking to make the lower two more "permanent".

When I only had the lower two plugged it made no difference. Having all 4 plugged changed things massively. Therefore I feel that if I started to have overflow problems, they can always take out my upper two plugs, and allow some drainage. I would not ever consider cauterising all 4, because I want some ability to go back some.

But when I explain that, no-one seems to agree.

Nik.

[Guest]

Nik

It makes sense to me. I guess your suggestion still gives the option that you can remove the top ones when/if they are not needed.

I have just had the heating on here and it is really playing havoc with my eyes. I am thinking now that I might get temporary ones again in the top - I don't think it can cause any harm.

I don't know whether plugs make a difference for me or not. I am OK during the day so long as I am not in the heating, or using a computer. The moment that one and particularly both of these elements come together I just want to find a quite place and scream.

To be honest, it is a little difficult to avoid both of these when firstly I am an IT consultant and secondly I work in an office environment with a bunch of people who buy jackets as fashion accessories for the back of their chair.

Good luck with it

Ian

[Rebecca Petris]

I am OK during the day so long as I am not in the heating, or using a computer. The moment that one and particularly both of these elements come together I just want to find a quite place and scream.

To be honest, it is a little difficult to avoid both of these when firstly I am an IT consultant and secondly I work in an office environment

SIGH. No doubt.

Ian, a long time ago on a bulletin board far far away for laser eye surgery patients, we had a sort of group therapy thread - an ongoing fantasy session started by a community member named Moose. It was about a Caribbean island, I forget now what they called it (SE Island or something?) where the chief refrain was that everywhere you went it was "well-lighted and moist". We dreamt up all sorts of dry-eye-friendly perks for both home and office. Seems like we need to revive that around here to help us through the winter. I don't know if the original is still around or if anybody kept a copy (Mary? Lucy?).

[Guest]

Sounds like a great idea. My life at the moment is a fantasy - I spend too much time thinking of all the things I used to be able to do before I had laser surgery and how I am going to fit everything in that I have missed out on when I finally recover from this.

I just want to be me again.

I think Winter is the toughest for us all - plugged or not plugged. I think I will ask for plugs again tomorrow - it may just help, feeling really down about my eyes tonight, heating is playing havoc - even fetched the humidifier down from the loft, just one of those days where I can't do anything to get them right.

Sorry we have deviated from your post Nik.

Cheers

Ian

[kakinda]

Well Ian,

it's still you under different and adverse conditions (at least that's what I tell myself... but my problem is chronic, it sounds like you are considering overflow of tears... that's great!). It's just a new kind of you (especially for those who are around you) redefining oneself. So it's even better if you improve (it will still be you with an additional life experience... with a better insight of disability in a society that disregards it).

Anyway, cautery being permanent may lead to complications beyond overflow (imagine just for instance that you develop meibomitis, an increase of allergies, not to mention more unpleasant things)... So consider the residence time and the quality of tears in the long term. I guess that's why you docs is "unwilling"... or cautious.

I would stick to reversible treatment whenever possible...
take care
K

[SusieD]

Meibomitis, increase in allergies or other problems could also potentially post problems if you have 'permanent' plugs also.

I dont think anyone should assume plugs are always reversible, yes generally they are. However people do experience problems with plugs migrating, causing scarring etc not only with certain intracannalicular ones but also with the capped ones when they get pushed down where they're not supposed to go!

Depending on the doc (and their competence) doing it, you could have all these problems and more with plugs. I dont think they are always necessarily more beneficial than cautery, you could still have problems. Its rare I know, but people have had to have some quite major surgery to remove embedded plugs etc.

[Rebecca Petris]

Ugh. I was just reading last night a new abstract on 28 SmartPlug complications cases... including 13 canaliculotomies (you don't want to know) and 4 dacryocystorhinostomies (you really don't want to know). The authors also acknowledged that trying to irrigate out a SmartPlug "may dislodge the plug from its canalicular position and cause permanent obstruction of the lacrimal drainage system."

I think back to when I had SmartPlugs put in years ago - I certainly did not take it very seriously at the time, and they were wonderfully comfortable, but I would feel differently about them now. Not trying to pick on this particular product, and yes in percentage terms it's relatively low risk - it's just that the more I hear the less I like the idea of having any durable material sitting in my canalicula. (Ian recently suggested another use for them, but we won't go there )