Temporary punctal cautery almost a huge success!

[thedude0001]

Hi folks,

Went to my ophthalmologist a week ago and told them I wanted to try punctal plugs. They said they only do cauterization and that they could give me a "temporary" cauterization same day. Doc said puncta would open back up within a month.

Here's how it went so far...

First 3 days after cautery were AMAZING. I had such good lubrication. Practically zero symptoms. Life was so much easier not dealing with dry eyes!
The next 2 days were still really good but not quite as great.
Just today I think I can see the little punctal holes again and I'm back to being burning dry sadly. I was hoping it would last a bit longer, but when I see the eye doctor next week they said they can do a permanent cautery which I'm trying to be hopeful about. At first this seemed like a silver bullet for me.

Has anybody here had success with punctal cautery or plugs?

[L8rgator]

I had "permanent" cautery, and the results were amazing. For a few weeks my eye went back to practically normal. Then they got bad all the sudden again. He said they had opened up, much to his surprise, so we did them again in the office this time (the first time I had it done with a tarsorrhaphy under anethesia, and only bottom). It was much improved again for maybe a week, so I went back in about a month and he said he thought they had opened up again, so they started to alternate between plugs and more cauteries (this time he included the top). It never made any improvements after that second time. Each time he really mangled it, to make "sure" it was permanent. My theory is that the surgery maybe irriated my eye enough that for some reason it was making reactive tears for a short period of time. Once that dried up, the plugged ducts no longer made a difference. I get the subtle impression my doctor seems to silently think I was just crazy. I don't know if it's possible to placebo effect new tears, but whatever.

[DCRdryeye]

Three weeks ago an oculoplastic surgeon placed temporary stitches with a bolster over the top of it on my lower left puncta to 100% occlude it. The procedure was a "test" to see how cautery may perform for me. The relief was amazing, and it's my driest eye too!! Just had the sutures removed today.

I was more concerned about the Permanency of cautery and thus refused it for several years. Yet I read so many stories about cautery "opening" again. I guess it's one of the perks of surgery, when you 'close' something in the body, it wants to open it again, and vice-versa.

For the first time in several years this new oculoplastic surgeon whom stitched my puncta said he can certainly "reverse" cautery with a new surgical tool available. It also depends on who performs the cautery, and the surgeon needs to know the patient may want reversal in the future. Thus, only the 'puncta' and not the entire canaliculus is cauterized. So I will go ahead with cautery in a few months.

[thedude0001]

Update;
Saw my specialist again and had another cautery. This time I again had a couple good days, but the effect wore off again. It's like what you were saying L8rgator, it causes your eyes to tear from the irritation. I've yet to have the uppers cauterized, hopefully that helps more. It'd be nice to just have no drainage since I'm on prednisolone steroid drops that taste horrible when they start draining into my nasal.

I'm really disappointed that this isn't the silver bullet I thought it was, but I'm hopeful that I can recover from this. My eyes have been horrible this year and at least they are improving slightly. I'll keep you guys updated!