Cautery Anyone?

[Guest]

. (Ian recently suggested another use for them, but we won't go there )

I edited that post - forget we were a family site.
Ian

[kakinda]

SusieD you said

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

but you may remove them even if using surgery... that's precisely my point: reversability of options.
my experience tells me to stick to reversible treatments... just giving an opinion on why docs are unwilling to perform permanent cautery... and for once i believe there may be very good reasons behind that. I believe that most experts i saw share this point of view.

take care
K

[np1981]

Well none of the Drs I've seen mention those concerns. It doesnt explain why they would consider young age a problem. If I were 60 they'd do it - no problem.

The only explanation I have been given is that my eyes may overflow in the future, and that I may need to reverse the occlusion if that happens. I've said that I only need the lowers done.

[Flick]

Fascinating how cautious these eye doctors are with an irreversible procedure like punctal cautery. Where are these doctors and where is the caution when it comes to LASIK? In my mind the potential complications of cautery don't really compare to those of refractive surgery.

(disclaimer: I've never had RS, just been saddened by following stories over at lasermyeye.org)

np1981 - maybe if you could make up a consent form you could find someone willing to cauterize in the UK? Good luck.

[SusieD]

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 )

Rebecca - did you ever have yours irrigated out? Or were they just left?
Thanks.

[SusieD]

SusieD you said

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

but you may remove them even if using surgery... that's precisely my point: reversability of options.
my experience tells me to stick to reversible treatments... just giving an opinion on why docs are unwilling to perform permanent cautery... and for once i believe there may be very good reasons behind that. I believe that most experts i saw share this point of view.

take care
K

I do get that, however, you say that they can always be removed - even with surgery. Yes, surgery that could well cause a lot of damage to the lacrimal drainage system. Not a very comforting thought imo.

I personally have NEVER heard of anyone overflowing just having lowers occluded. Not saying it hasnt happened, just that Ive never heard about it.

[Rebecca Petris]

Fascinating how cautious these eye doctors are with an irreversible procedure like punctal cautery. Where are these doctors and where is the caution when it comes to LASIK? In my mind the potential complications of cautery don't really compare to those of refractive surgery.

Indeed (sigh).

If reversibility of plugs is defined as the ability to remove from the front or irrigate them out, reliably, fair enough. But if it ultimately involves cutting up a lid to get it out, that's not what I'd call reversible. Don't get me wrong, not trying to bash plugs here, but often the people who go for plugs or cautery are the very people whose ocular surface is already in such bad shape that they can least afford to have iatrogenic additions to their eye problems.

I think part of the problem of discussing this on the bulletin board is, the information available to us is limited. We have seen a lot of plug horror stories relayed by patients and we've seen them in the medical literature, but we've had very few stories (or studies) to read about the downside of cautery so we're not really comparing apples to apples. I don't know how to change that. If anybody has more concrete information or personal experiences to relay about cautery, we'd all appreciate seeing it.

With the frustrations of front-end plugs falling out and being costly to replace, and the fears of complications from intracanalicular plugs, I think it's understandable that some patients are more than willing to consider the devil they don't know over the one they do.

[np1981]

Where can I find out more on the downsides to cautery?

[indrep]

Just a thought or two. It seems long but I had to condense many years of observation into something semiworth reading. :-)

It is difficult to know how many plugs a re inserted annually, but if I was guessing it would be around 300,000. The number that actually require surgical intervention to remove, based on my knowledge and experience, is less than 1/10th of a percent. So the risk of having to damage tissue is considered miniscule with punctal plugs compared to 100% of cautery patients leave with altered tissue. The issue is plugs are a less invasive procedure than cautery so it is the path taken first.

Having said this some patients who have benefitted from plugs but cannot keep them in long term are probably candidates for cautery. This is a medical decision that has to be made by the physician and patient together.

Unfortunately in today's legal environment if cautery was a first stage procedure many people could forget the informed consent part about possible excess tearing and then there might be a legal issue to resolve. In other words the doc gave relief of one issue but created a secondary problem that the patient is just as unhappy with. Remember cautery can be a forever thing and if your young you never know what might change.

[np1981]

Thanks for your thoughts indrep, really appreciate it.