Cautery more effective than plugs?

[Matt0029]

Thanks it appears to be quiet abit drier then when it had a plug in it. May have to look in to cautery my eyes have been getting drier and drier since stopping the steroid drops,

[Rebecca Petris]

Is there any way of telling if the plug is in there?

Not definitively, no.

[Matt0029]

I would be surprised if a doctor was willing to cauterize if you told them there was a plug possibly still in there for fear of being blamed for complications. I've had plugs inserted too deep before and they usually would get itchy, inflamed and then I was able to pushed them back out again. That being said it is possible I could still have one or two still in there that I haven't noticed over the last six years since sometimes it's hard to know for sure if a plug fell "out" or possibly fell "in?" Anyways if it were me I would probably wait a good amount of time till I was confident that it wasn't going to get infected and that I didn't feel anything weird before considering cauterizing over it. However, from most of the posts I've read cauterized punctum have a great tendency to reopen if not done well. I remember reading several people recommending to have the doctor suture the tear ducts closed along with cauterizing to be sure it was closed for good.

http://forum.dryeyezone.com/forum/dr...gs-have-helped


It really depends on where the plug is located. Can you feel it near the tear duct? If so it might only be in a little ways and if infected would probably push out rather easily whether cauterized or not. If however it's fair inside and gets infected they could possibly try flushing it out with saline if it wasn't cauterized. But would probably push for surgery either way cause they can make more money that way. The third possibility is it might have migrated it's way through and is no longer in there if you no longer feel it.

I cant feel it no, they cut my punctum so they could see/ fish deeper in to get it out but they couldn't find it. I now have a large punctum opening from were it was cut. Which if the plug isn't there will be making my dry eye worse. My eye has felt drier since this, which was about 6months ago.

[Matt0029]

I would ask them if they can provide any information on risks of cauterizing if a plug is lodged in there somewhere, for example, if that plug causes issues down the road will the cauterization make it harder to treat?

Is there any way of telling if the plug is in there? I'm not so sure it is as my eye has felt a lot dryer since they cut the punctum to try remove the plug that had migrated. I have quiet a large opening now because of this and the eye seems to be drier. Looking at wanting to try cautery in that eye because if the plug isn't there I just have a large opening in to my lower duct making it worse.

[Matt0029]

Thank you they tried to remove it after it was pushed too far in. They cut the tear duct open abit more to try get it. But they couldn't find it. I think it has pushed through as the eye feels dryer than it did with a plug in place. Hence why I want cautery in that eye really as I now have a large punctum opening after they tried to remove it.

[PRK]

I have a plug in my right eye lower duct. My left eye I had a problem with a plug it was inserted too far in to the duct and my doc had to cut the duct to try get it out but he couldn't get to it. So it in apparently lodged in there somewhere, Not sure though as my left eye is the drier of the two and hasn't felt as moist as it did with a plug in place. if its in there somewere it doesn't seem to be blocking the draining as much as a plug that was correctly placed did if at all. It mainly the left eye I am looking at cautery if doing one eye is possible. My eye left tear duct opening is obviously in larged from being cut open. I at 30. Started if dry eye about 2-3 years ago. Which got worse till I needed steroid eye drop and now just ikervis.

I would be surprised if a doctor was willing to cauterize if you told them there was a plug possibly still in there for fear of being blamed for complications. I've had plugs inserted too deep before and they usually would get itchy, inflamed and then I was able to pushed them back out again. That being said it is possible I could still have one or two still in there that I haven't noticed over the last six years since sometimes it's hard to know for sure if a plug fell "out" or possibly fell "in?" Anyways if it were me I would probably wait a good amount of time till I was confident that it wasn't going to get infected and that I didn't feel anything weird before considering cauterizing over it. However, from most of the posts I've read cauterized punctum have a great tendency to reopen if not done well. I remember reading several people recommending to have the doctor suture the tear ducts closed along with cauterizing to be sure it was closed for good.

http://forum.dryeyezone.com/forum/dr...gs-have-helped


It really depends on where the plug is located. Can you feel it near the tear duct? If so it might only be in a little ways and if infected would probably push out rather easily whether cauterized or not. If however it's fair inside and gets infected they could possibly try flushing it out with saline if it wasn't cauterized. But would probably push for surgery either way cause they can make more money that way. The third possibility is it might have migrated it's way through and is no longer in there if you no longer feel it.

[Hokucat]

The lowers cauterized and uppers plugged.

[Matt0029]

Matt, I have not had cautery, but my friend who had severe dry eyes did, and she previously had plugs. Her dryness has continued to get better, to the point where she has excessive tears overflowing and wishes she stayed with plugs versus cautery. She told me they could reverse the cautery, but how easy and successful it is to do that depends on how deep down they had cauterized (burned) from the top of the tear duct.

https://www.notadryeye.org/all-about...nctal-cautery/

So if you do decide to do cautery, sounds like it should not be done too deeply, in case your condition improves and you need to reverse the procedure.

Sounds like you are concerned about leakage with punctual plugs and not retaining enough tears? If so, have you tried having both your uppers and lowers plugged at the same time, to see if that helps more? Or are you having problems keeping the plugs in?

How long have had dry eyes? Would not recommend cautery unless the dryness been going on for many years, you can tell punctual plugs have given you some degree of relief, and other treatments have not worked.

Did your friend just have the lower tear ducts cauterized and now has overflow? Or did they have all four done?

[Matt0029]

Thank you. It's manily the left eye I am looking at getting cauterized. If just doing one eye is an option. I have a big hole for my bottom punctum as they cut it to try to remove the plug.

[Rebecca Petris]

I would ask them if they can provide any information on risks of cauterizing if a plug is lodged in there somewhere, for example, if that plug causes issues down the road will the cauterization make it harder to treat?

[Matt0029]

Thanks for the reply Rebbeca, it would be the removal of a punctual plug in my right eye for cautery. My left eye had a punctual plug pushed too far in to the duct so they think it is lodged in there though the eye feels drier since the plug is no positioned correctly and is possibly in the duct but I don't think fully blocking it. Maybe it worked I way through the duct? Was a 0,6mm plug. They tried removing it but couldn't find it.

[hannahmaywils]

How long had you had dry eyes before you had cautery?

My eyes have got gradually worse from the age of 21, I am now 24.

[farmgirl]

I have cautery on the uppers and plugs on the lowers. The plug leaks a bit because I can taste medicated drops at times but I would say it is less than 20%. I would not recommend cautery for all 4 in case you do improve. My dryness is pretty severe but I still hold out hope that I will improve to the point that I don't need them all plugged because over tearing would be a nightmare.

[Rebecca Petris]

Anyone had plugs the undergone cautery.

Are you talking about a case where the plugs are punctal and then removed, or where you have intracanalicular plugs in place (which is often done). The latter can get ugly if any complications arise.

[Matt0029]

Matt, I have not had cautery, but my friend who had severe dry eyes did, and she previously had plugs. Her dryness has continued to get better, to the point where she has excessive tears overflowing and wishes she stayed with plugs versus cautery. She told me they could reverse the cautery, but how easy and successful it is to do that depends on how deep down they had cauterized (burned) from the top of the tear duct.

https://www.notadryeye.org/all-about...nctal-cautery/

So if you do decide to do cautery, sounds like it should not be done too deeply, in case your condition improves and you need to reverse the procedure.

Sounds like you are concerned about leakage with punctual plugs and not retaining enough tears? If so, have you tried having both your uppers and lowers plugged at the same time, to see if that helps more? Or are you having problems keeping the plugs in?

How long have had dry eyes? Would not recommend cautery unless the dryness been going on for many years, you can tell punctual plugs have given you some degree of relief, and other treatments have not worked.

Great link thanks