Cautery Appt Booked : Having 2nd thoughts...

[vancouver]

Great Forum ! This is my first post here.

I'm 29, I've had severe dry eyes for about 14 years. It wasn't until last year, that I finally had temporary punctal plugs put in (bottom). It was an amazing feeling. I sat right in front of the fireplace that night to test out my new eyes. It worked!

Unfortunately the left plug popped out the next morning.

I went back and had "permanent plugs" put in. (the kind that expand). I'm not sure of the brand name. Again, it worked wonders, and I couldn't feel these ones at all. Everything was great for a number of months.

I was told they were permanent, so I was confused when my eyes started getting severely dry again in the summer again. I dealt with it, and was back on Thera Tears eye drops every 1hr (not as effective as the plugs).

After a checkup recently, my optometrist told me the "permanent plugs" were no longer in effect and must have fallen out. Also, she was concerned because my eyes were severely dry. She suggested cautery.

So that brings me to today. My appt. is booked for next week. After reading this board, I'm having second thoughts on cautery. Firstly, it troubles me that my optometrist said only 1 in 10,000 people probably end up going for cautery in Vancouver (so how much experience could the doctor possibly have!). Second, it doesn't sound like thermal cautery is an exact science, if it will end up re-opening at a later date and requires multiple attempts (sounds like a lot scarring!). Finally, Am I rushing into this ? I've done all the research I possibly can, and it seems the more I research, the more I'm having second thoughts.

Unfortuntely, the alternatives are not much better burning red eyes n' all . Do you think the technology will get better ? Should I just try punctal plugs again and wait for something better to come ?

Thanks in Advance,
AC

[indrep]

I would try punctal occlussion again. If your doc is reluctant to use "permanent" type you could suggest the 90 day version and see what happens.

[Silverlady]

Do you know why

Do you know why you have such dry eyes? Have you been seen by an opthalmologist(doctor specializing in eye diseases) instead of a optomologist ( doctor who prescribes eye glasses)?

Billye

[neil0502]

I'm with Indrep.

If you're having second thoughts, then .... IMHO ... there's your answer.

You can ALWAYS go forward. You really CAN'T go back.

Wait 'til your ready. The "improvement" over «well fitted» plugs is really fairly insignificant anyway.

My, but this board is getting a lot of new people. If it could, I think it would bring tears to my eyes.

Welcome aboard....sorry to have you here.....and all the best in this PITA struggle we're all in......

Beautiful province, BTW. Did 2wks there once....Nelson, Castlegar, Kamloops, Vancouver, etc., etc.

Neil

[vancouver]

hi. an update.

I ended up going for my appointment which was scheduled with one of Vancouver's best ophthalmologists. They were so professional and experienced, that I decided to go for the cautery of my lower two punctas.

So far so good. The procedure was rather painless. My eyes feel better, but I was told it'll be a week or two before I really notice the results, and will have to go for a follow up to make sure the cauterization has kept intact and not opened up. My eyes still feel a bit "tired", but far better than they were this morning before the procedure.

[neil0502]

I'm glad you were able to come to a decision about this complex issue.

I've heard, by the way, that the drainage is about 60% from the lowers and 40% from the uppers BUT that the balance shifts if you plug the lowers. In other words: some have said that if you plug/cauterize the lowers, the uppers will simply begin to drain more. Did you/will you PLUG the uppers to try to keep the body from fixing this "problem" on its own??

Just food for thought. I hope it all works out for you. Think you were smart to only do two holes at a time, too.....

[SusieD]

This is what I read too.

The body often 'compensates' for things not being right as much as it can.

Regarding occlusion, in some people the upper ones take over all the drainage. This would explain why some people notice no difference with just the lowers alone and then WOW when they plug the uppers.

[vancouver]

it's been 1 week... since my cauterization of the bottom two puncta and it's been nothing less than AMAZING !

I was able to go to the local shopping mall and shop for over 4 hours... previously my eyes would be bloodshot within' 5 minutes of stepping into the mall. Strong colognes and perfumes no longer dry out my eyes. Also, extended workouts at the gym also had no resulting redness.

While cauterization clearly did the trick, I also had a condition called :
Giant Papillary Conjunctivitis which is also being treated for 2 weeks with FML® (fluorometholone ophthalmic suspension, USP) 0.1% is a sterile, topical anti-inflammatory agent for ophthalmic use.

I'll be going in for a checkup in 2 weeks.. to make sure the cauterization hasn't opened up... I'll keep you guys posted. Thanks for the help...

[np1981]

How did you get GPC?

[vancouver]

I'm not sure how I got GPC. It certainly wasn't visible to me ... nothing like the pictures you see on google.

[neil0502]

I'd be VERY interested in something here:

Did you get BASELINE testing (before cautery) of your Schirmer's AND Tear Breakup Times??

Can you ALSO ask them to check BOTH of those metrics regularly for the next few visits/months???

There is STILL a theory out there that the body will ALWAYS try to compensate. That is: there was a pretty good improvement when I first had lower plugs....then things got worse. Another good improvement after upper plugs....then things got worse. Another good improvement after four-way cautery....then things got worse.

In MY case, I'm sure most of that was because of continued, concurrent use of BAK-containing drops, BUT....I'd be VERY INTERESTED to know if your eyes backed down the order for plumbing as a perceived response to additional tears.

All the best. Glad you're initial impressions are so good ... and hope they continue to improve!

Neil

[SusieD]

I think this could happen also with too much tear supplementation - your own decreases etc (very frequent application I mean).

Of course there is no real evidence to support this - I only saw one study that showed tear production decreased with just frequent use of artificial tears. I am also not advocating people stop using drops frequently - if you need it you need it.

It just interests me - I know on the days when I use more drops, I tend to feel worse.

[indrep]

I am inclined to believe the volume of tears is not what causes increased or decreased volume of tears. If this was the case, if your tears are evaporating quickly your eye would sense a lack of tears and thus an increase in tear volume would be present.

Patients with dry eyes whose symptons instigate the cleansing/reflex tears due to discomfort are plugged they notice a decrease in tears. when your eye senses a foreign body it trys to wash it out with the cleansing/reflex tears. This is a decrease in the "bad" tears not the good tears. Think of good/bad cholesterol.

[SusieD]

I get what youre saying - sounds logical.

[vancouver]

Hello,

I had my 2nd appointment last week, it went well. My left lower puncta had opened up, but they sealed it back up a little more deeply this time.

The assistant Dr. told me my eyes apparently are still dry, but alteast they don't burn or get red like before. I'm fairly happy with the results...

Since I have been dealing with this from my teen years, it shaped my ability to make and *hold* eye contact. So this is something I've got to learn now that I am a lot more confident in my healthier whiter eyes.