Cautery more effective than plugs?

[Matt0029]

Anyone had plugs the undergone cautery. If so was cautery more effective at retaining tears? Think I was told you can still get 20% leakage around plug. Thnaks for any advice.

[Hokucat]

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.

[hopeful_hiker]

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.

Always awesome to hear about someone getting better.

[hopeful_hiker]

I have punctal plugs. Parasol in one and silicon cylinder one in the other. Parasol has about 10% drainage according to the doc. The cylinder one hides deeper in the duct and he leakage is 30%-40%. Cautery is obviously 0%. If you can tolerate parasol, I’d recommend getting them. I wish I could have it in both eyes but it started rubbing one of my eyes so I had to opt for a basic plug.

[hannahmaywils]

Hi Matt,

I have had permanent punctual cautery on my lower tear ducts and I have plugs in my upper. Best decision I ever did I had to have the procedure re-done as they re-opened but my specialist re-assured me that they won't be opening again!

I still get dry eyes obviously, but nothing like I did. I use my drops every 4 hours maybe. They help the drops stay on my eyes for longer Feels good.

I've been really tempted to get all four tear ducts cauterised, but as im only 24 I can understand why my specialist is hesitant to do this. However, I have read stories of people who have had great success with all four tear ducts.

All depends on the severity of the dry eye. Mine were bad! Eye drops every 10 minutes.

Best of luck

[Matt0029]

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.

[Matt0029]

Hi Matt,

I have had permanent punctual cautery on my lower tear ducts and I have plugs in my upper. Best decision I ever did I had to have the procedure re-done as they re-opened but my specialist re-assured me that they won't be opening again!

I still get dry eyes obviously, but nothing like I did. I use my drops every 4 hours maybe. They help the drops stay on my eyes for longer Feels good.

I've been really tempted to get all four tear ducts cauterised, but as im only 24 I can understand why my specialist is hesitant to do this. However, I have read stories of people who have had great success with all four tear ducts.

All depends on the severity of the dry eye. Mine were bad! Eye drops every 10 minutes.

Best of luck

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

[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

[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.

[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.

[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.

[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.

[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]

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.

[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?