Feedback from those who are quadra plugged and/or quadra cauterized

[No tears in ATL]

Hi all. It's been awhile. Life has been crazy. Apparently crazy enough to induce my latest flare-up. Couldn't take it anymore so made the appointment.

History--my docs last year only wanted to plug the top ducts, since they take a more cautious approach (this, I can definitely appreciate). Couldn't plug one top duct because it was so small, so they cauterized it, and it popped open over this past year. A plug is still in the top of other eye.

This flare-up was bad enough to warrant another approach. So today, I got the bottom ones plugged with the Eagle, smooth top plugs. So far so good.

But they didn't want to re-cauterize the top left one--which is in fact the worst one. The right eye that is double plugged feels good so far. Left eye, ok, but could be a lot better I think (yes! I am tear greedy!).

Have any of you with either all four plugged or cauterized had any bad experiences, with inflammation or otherwise? I read somewhere about the "backup inflammation" phenomenon, but am not sure of the truth of it. I trust my doctors who have been very cautious so far but would like to make the case next visit to go ahead and cauterize that top one.

BTW, I am aqueous deficient. Lipid profile, etc., looks good according to last evaluation. Thanks for any suggestions, personal experiences.

[BigNate]

I had both lowers plugged and noticed a little improvement. Hoping for more improvement, I also got the uppers plugged. This led to excess tearing that eased up as the day progressed. Despite the fact that my eyes never felt dry, I can't say my overall comfort increased any. There was always this sick/nasty/allergy/disgusting/someone just puched me in the face feeling in my eyes...or like my eyes were watering as if I had to sneeze. It wasn't necessarily bad, but it surely was no fix for me.

One weird thing I will note is that my eyes are worse now after getting the uppers removed. As just a relative measure, its like I progressed from a rating of 5-->5-->2 as I moved from lowers-->all 4-->lowers. I have to wonder why?

[No tears in ATL]

Thanks BigNate. Are you planning on having the uppers put back in, then? Seems like watery would be a better trade-off than dry/burning.

Dry eye is a truly fickle it seems. For a while there my serum tears were working and now its as if suddenly one day the eyes decided that they were just going to remain red and burny no matter what. Maybe I just reached a plateau or something, who knows. This is where bottom plugs had to come in.

[Guest]

Have any of you with either all four plugged or cauterized had any bad experiences, with inflammation or otherwise? I read somewhere about the "backup inflammation" phenomenon, but am not sure of the truth of it.

True, some find their eyes get worse when all 4 puncta are blocked off (whether with plugs or cautery) because any inflammatory substances in your tear film will stick around longer.

But, eyes that have insufficient tears on their surface will have inflammation from THAT too.... having all 4 puncta blocked can therefore reduce inflammation in that sense - more tears hanging around = less inflammation since the eye was badly in need of the tears in the first place, right?

Question is, which of those 2 possible effects will be stronger for you personally?

In my case, I feel MUCH better with all 4 puncta blocked. It improved my eyes enormously.

The only issue I have is that my upper left puncta (cauterized 3 times now), keeps re-opening. First time it re-opened within a couple of weeks, 2nd time it re-opened after about 5 weeks, 3rd time it re-opened after 4 months. I'm still debating whether or not to have them do it yet again... but I feel like I'm tempting fate to have a burning hot device so close to my eyeball again (nothing bad has happened yet... but still... what if this time the doctor sneezes at a bad time hehe... hell, what if I sneeze at the worst possible time! )

In any case, if you felt better with all 4 plugged, I'd remind the doctor of that (plus mention any tangibles like "I was finally able to use the computer in comfort for about 1 hour at a time, whereas without all 4 plugged, my eyes hurt too badly to continue after only 10 minutes" or "With all 4 puncta blocked I was able to decrease my usage of artificial tears from once every 1/2 hour to once every 2-3 hours" etc. Plug in whatever the numbers are for you personally, of course!) I feel like giving them very specific measures of an improvement (particularly if they can't see for themselves improvements in things like Schirmer's scores or TBUT etc.), helps them justify in their own minds why they should do this to you (ie. cauterize your puncta).

[No tears in ATL]

Thanks SAAG! That's a great idea. I'll try to pay close attention over the next few weeks until follow up and make some notes on particular measures. I guess it sure helps giving the docs true numbers versus "yeah, but they just feeeel better..." lol

Gosh, I wish your puncta would just close already--that is so frustrating! Wish they would just invent some kind of non-toxic puncta putty/caulking for this sort of thing!

[LaDiva]

I am glad you posted this No Tears. My bottom ducts have been plugged for some months now, and it helped, but I still need to wear goggles to be comfortable. Next week I am having the tops plugged too, and hope this will do the trick. If it does, I will consider having the tops cauterized, but think I will leave plugs in the bottom. You can never tell. Sometimes miracles happen, and I figure this way, I would still have a couple of drain pipes that work! Best wishes to you.

[Guest]

Gosh, I wish your puncta would just close already--that is so frustrating! Wish they would just invent some kind of non-toxic puncta putty/caulking for this sort of thing!

Me too! lol

Part of me thinks that since the trend seems to be that it stays shut longer each time I get it cauterized, that maybe I ought to just do it again... maybe this time it will stay shut for a year... who knows... (I don't dare hope for a permanent closure at this point...)

It re-opened back in April... and after the initial #$!#@!#@$!#%$%$#&*$!!!!! reaction wore off, the indecision kicked in...

What to do, what to do...

[MartyM1985]

I'm quad, all Eagle plugs. They help tremendously. Definitely saw a difference going from 2-4.

I have slowly been improving since I hit rock bottom in January... that's when I went from 2-4. The plugs definitely have had a big hand in me getting my life back.

[farmgirl]

I am aqueous deficient but apparently my oils are fine. I am quadra plugged, well not plugged really but cauterized on the uppers and plugged on the lowers. Like you I want to leave a couple of drain pipes in the event of a miracle. Unlike SAAG my cautery was PERMANENT the first time. He must have done a bang up job and I am glad that he did. I was swollen and bruised for 2 weeks where as no one else here seems to have been after cautery but I also am not complaining that they are coming open.

I am immensely better with the plugs. When I first had them done they only plugged the uppers and that didn't help at all. Then they only plugged the lowers and again, that didn't help. Finally I had all four plugged and bingo, that made all the difference. I even get the odd tear that sneaks out, mind you I am still having to use drops but not nearly as often. I, like SAAG I still have to wear the goggles but I am ever so much more comfortable than before.

I have never had any bad experiences, with inflammation or the "backup inflammation" phenomenon. I say quadra plugged is the way to go for aqueous deficiency be it cautery or plugs...I am very happy that I did. I have also been lucky to have a Dr. who happily gives me whatever I ask for, no questions asked. He has even offered to cauterize the lowers but, like I said before, I am still waiting for my miracle. If need be follow SAAG's advice for the convincing game or change to a Dr. who believes that you want to take charge of your own condition and make your own decisions. Plugs are not permanent so not sure what his/her problem might be. I chose to cauterize the uppers because the plugs felt like they were scratching my eyeballs. Whatever you do though don't get the permanent intercanular type plug because those can cause problems.

I wish you luck...cheers...F/G

[No tears in ATL]

Ok-sorry to seem like a worrywart, but were your eyes red for several days after getting plugged? I would say that they feel ok, but I can't understand what is happening with this redness and veins. Is it a reaction to those green staining drops they put in to test my pressure? This just doesn't seem right.

I've still got my steroid drops. Wonder if I should put those in for a few more days. I thought we had any inflammation under control by now...sheesh. Starting to get a little scared.

[patientpatrick]

I'm currently quadra-plugged and there are pros and cons. The biggest con is I can feel the plugs. It's like i have 4 grains of sand along the sides of my inner eye. The biggest pro is I've cut my eye drop usage done substantially. Ironically though, my schrimer scores have decreased from being plugged. Some of the other things i've noticed is that my eyes have become more sensitive from being quadraplugged and I believe that the plugs are stretching out my puncta because I've had to have them replaced 3 times and each time required a bigger plug.

[Guest]

I believe that the plugs are stretching out my puncta because I've had to have them replaced 3 times and each time required a bigger plug.

Or it could be that the dr. selected plugs that are too small each time, so every time they come loose, he naturally will try a size up.

I wonder if he measured your puncta prior to putting them in? They are supposed to.

[No tears in ATL]

I'm currently quadra-plugged and there are pros and cons. The biggest con is I can feel the plugs. It's like i have 4 grains of sand along the sides of my inner eye. The biggest pro is I've cut my eye drop usage done substantially. Ironically though, my schrimer scores have decreased from being plugged. Some of the other things i've noticed is that my eyes have become more sensitive from being quadraplugged and I believe that the plugs are stretching out my puncta because I've had to have them replaced 3 times and each time required a bigger plug.

Oh no! Maybe they will cauterize if size becomes an issue. I thought there was some cautery technique where they could stitch it closed (maybe I dreamt that though). One of my ducts is done and it was easy as pie--but it popped open this year. They really need to invent this punctal putty soon.

I should get on that...could be a millionaire yet.

[LaDiva]

Patrick, I had multiple sets of plugs before I changed eye doctors. All of them fell out, and rubbed against my eyes. The old doctor kept inserting bigger and bigger plugs, and they drove me batty. The new doctor's plugs rarely bother me, and they haven't come out. I am guessing it is the kind of plug you are using that is giving you the problem, and it might also be the size. I can't tell you what kind I am wearing, but go to the doctor next week, and if I can remember will ask.

[patientpatrick]

I believe my puncta was measured. The doc keeps an electronic record of all the plugs put in. To be honest I think some of them fell out during lid massages. I've considered cautery but one of the docs i've been seeing is totally against it. He believes that it may alter the shape of my eyelid and it could cause a cascading effect of inflammation. At this point I don't want to risk anything permanent. Also, I have a nagging feeling that since my schrimer scores are lower since I've been quadra plugged, they may increase if i have them removed somewhere down the line. At least that's my hope.