Can cautery work if collagen plug did not?

[JJdryeye]

A few years ago an ophthalmologist tried a collagen plug in my right eye. Not only did it not work, it made my eye extremely irritated for 2-3 weeks until it dissolved. Is it possible that I could have a different experience with cautery or partial cautery?

[NotADryEye]

I was unable to tolerate plugs for even five minutes.
Eventually my lowers were cauterized deeply. Later my uppers were cauterized shallowly and are now partially reopened.
Yes, cautery can work when plugs don't.

[indrep]

A few thoughts.
If occluding the puncta was the source of the irritation I would be very hesitant to do something so permanent and tissue changing as cautery.
I would determine what type of temporary plugs were utilized. There are no 2-3 week temporary plugs.
If you are not allergic to silicone, I would try a silicone plug and see what happens. They are easily inserted and easy to remove if necessary.

[JJdryeye]

A few thoughts.
If occluding the puncta was the source of the irritation I would be very hesitant to do something so permanent and tissue changing as cautery.
I would determine what type of temporary plugs were utilized. There are no 2-3 week temporary plugs.
If you are not allergic to silicone, I would try a silicone plug and see what happens. They are easily inserted and easy to remove if necessary.

I thought cautery was a reversible procedure. Dr. ****** in his book says "I create a thin scar which can easily be reopened, should the patient produce too many tears". I realize it would alter the tissue around the puncta, but are you suggesting that the scar tissue left behind after reopening might be enough to cause additional problems?

Yeah I may have misremembered, as Roger Clemens once said, about the time of the dissolvable plug. Either way, it was definitely a collagen absorbable plug. When you say 'type of plug', what are you referring to exactly? (manufacturer?).

[NotADryEye]

A few thoughts.
If occluding the puncta was the source of the irritation I would be very hesitant to do something so permanent and tissue changing as cautery.

The plug itself was the cause of irritation. I could feel it. There were no plugs small enough to fit my puncta. Ultimately, cautery was the solution. I am fortunate in that my cautery is without side effects. Uppers and lowers were performed by different doctors, but both very good.

[NotADryEye]

[QUOTE=JJdryeye;85716]I thought cautery was a reversible procedure. Dr. ****** in his book says "I create a thin scar which can easily be reopened, should the patient produce too many tears". I realize it would alter the tissue around the puncta, but are you suggesting that the scar tissue left behind after reopening might be enough to cause additional problems?QUOTE]

JJ, the way Dr. ****** performs the procedure, as you describe, is reversible in the office. Dr. ****** cauterized my uppers and months later after I began to produce more tears, over the course of a few weeks, reopened them partially. I have no scarring or any issue with the uppers.

My lowers were cauterized deeply by Dr. Tseng in Miami a few weeks before the uppers. This procedure, deeply cauterized, is not as easily reversible.

I'm not sure which procedure most doctors use or prefer or if sometimes it makes more sense, depending on the patient and the condition, or other factors, to do it one way or another.

[patientpatrick]

The plug itself was the cause of irritation. I could feel it. There were no plugs small enough to fit my puncta. Ultimately, cautery was the solution. I am fortunate in that my cautery is without side effects. Uppers and lowers were performed by different doctors, but both very good.

You state fortunately you had no side effects with your cautery. Is cautery prone to a lot of side effects?

[NotADryEye]

Some people on DEZ have reported issues e.g. the puncta opened after cautery. I don't know if this is common or not. I just know I didn't have any issues.

[LaDiva]

I've had permanent plugs in the bottom lids for awhile, and just got another permanent put in the top left today. My left eye feels much better, and I am considering having the right eye done on top as well. The eye doctor told me that if I had permanent plugs in the top and decided to cauterize, he would not be removing the top plugs, but would cauterize the bottom. He said the tops are often difficult to remove, and sometimes must be removed surgically. He also suggested partial cauterization, and if that wasn't enough, they could be completely closed. He added that partial closure would also enable them to be re-opened should a miracle occur. I had three sets of plugs inserted by another physician, and they all hurt and all fell out. The plugs I currently have do not hurt, and they have not fallen out. I think the comfort may also depend on the fit. Best of luck to you.