Has CAUTERY failed to work for you?

[DCRdryeye]

I'd like to ask all those whom have had lower punctum cautery whether it failed to work after a period of time? Not because the cauterization has failed (opened up), but because of the feedback loop between the ocular surface and lacrimal gland has been disrupted.

Post cautery, there is a sudden increase in moisture. It’s the heaven we’ve been waiting for. However, after awhile the moisture may disappear (despite the puncta still remaining 100% occluded). The initial ‘irritation’ from the cautery maybe stimulating tear production and when it heals the extra moisture may send signals to the lacrimal gland saying, “Hey, we have plenty of tears, decease secretion”. Suddenly, we are bone dry again.
Have you experienced becoming dry after having the lowers cauterized?

I ask this because my ophthalmologist is aware of such a problem and is suggesting Eagle flow control plugs. He can suture them in because my left puncta is too large due to DCR surgery. However, I don’t think they will work.

There’s usually a huge difference after being quadraplugged. Any feedback from those whom have had the upper punctum’s occluded too?

[farmgirl]

I've had the uppers occluded and the lowers plugged for 3 years now and although I still suffer somewhat I am infinitely better than I was before and for sure would never (at this point) go back. What was the worst for me was that I quit using the restasis for a time and got WAY worse even though I didn't recall the restatsis helping that much at the time. I have gone back to using it but am still not as good as I was...sigh...F/G

[lizzyk]

I had my lowers cauterised a few months ago as i had to have the plugs removed as they seemed to be irritating my eyes (I had them in for years with no problems!) After cautery i was still using drops regularly. I had plugs inserted in my uppers a couple of weeks ago and even though all my ducts were plugged/cauterised i still had to use drops, (my tears evaporate in 3 seconds even when all ducts are closed) Unfortunately i had to have the upper plugs removed after 10 days as they seem to be making my eyes worse, i cannot understand the reason for this. The op confirmed that the cauterised lowers were still sealed up. I am so fed up, i dont know where to turn next, unfortunately financially i am unable to pursue expensive private treatment

[DCRdryeye]

I had my lowers cauterised a few months ago as i had to have the plugs removed as they seemed to be irritating my eyes (I had them in for years with no problems!) After cautery i was still using drops regularly. I had plugs inserted in my uppers a couple of weeks ago and even though all my ducts were plugged/cauterised i still had to use drops, (my tears evaporate in 3 seconds even when all ducts are closed) Unfortunately i had to have the upper plugs removed after 10 days as they seem to be making my eyes worse, i cannot understand the reason for this. The op confirmed that the cauterised lowers were still sealed up. I am so fed up, i dont know where to turn next, unfortunately financially i am unable to pursue expensive private treatment

Lizzy have you tried 'Optimel' as a way to stimulate reflex tearing? My oculoplastic surgeon is toying with that idea for his non responsive patients who are quadra plugged or cauterized in all 4 punctae. He is considering doing a study on it. I'm booked in next month for cautery of both lower punctae and very much looking forward to it. If it doesn't work I'll go for plugs in the uppers. At least lubricants last longer on the eyes with the punctae occluded.

[lizzyk]

No i havent tried these drops, not sure where i could buy them?
I had a consultant appointment last Friday and he informed me my cauterised lowers were in fact slightly open so he has put plugs in them!! I will persevere with the plugs to see if they make any difference. ( though at the mo I am still putting drops in every 30 mins!) He recommended hot compresses and cleaning with diluted baby shampoo. There is no cure for blocked glands, he told me, just management. Arrrgh!!
If i could get 2 so called experts to agree it would be a miracle, its so frustrating!

[DCRdryeye]

May-be they didn't cauterize the punctum's deep enough. They should not re-open if done properly and with a stitch after the cautery process. I've consulted with an oculoplastic surgeon whom says she's never had a cautery open back on her.
I hope the plugs stay in. You could always get it cauterized again if the plugs irritate you or don't seem to retain any moisture.
The Optimel I recommended is specifically indicated for blocked glands.

[DCRdryeye]

Finally, after 7 yrs of debating cautery, I had it done a few weeks ago on October 2nd. It was fine for the first week then became bone dry again after that along with extremely painful, inflammed and itchy eyes at the nasal location. Whilst it’s our allergy season here, I’ve never had hayfever or allergic conjunctivitis. Well, I do now after cautery!! Not at all happy.

[DCRdryeye]

Since then, I've used Zaditen and it cleared the symptoms and have a prescription on hand for Dexamethasone eye drops if it gets worse. I now realize having cautery means I also experience seasonal conjunctivitis, however it's easily fixed with drops. It's "short term pain, for long term gain".

We all remember a time before 'dry eyes'. It's certainly made us value our health more and not take it for granted!!

[Guest]

It was fine for the first week then became bone dry again after that along with extremely painful, inflammed and itchy eyes at the nasal location. Whilst it’s our allergy season here, I’ve never had hayfever or allergic conjunctivitis. Well, I do now after cautery!! Not at all happy.

I've found that my eyes are in some ways MORE sensitive during the initial healing period after cautery - they may FEEL super wet and drippy, but somehow, the inflammation of the lid caused by cautery seems to make my eyes more sensitive with that amount of moisture than they would be otherwise. Once the cautery area has healed completely, I find my eyes get back to normal sensitivity levels. I've learned to baby my eyes in the first week or so after cautery, and after that, slowly return to normal activities, eyes permitting of course.

Similarly to what you describe, it is the nasal location of my eyes that itch something awful if I overdo it in the healing period after cautery... this is initially surprising since it's the LID that was cooked, not my eyeball (or that pink fleshy part in the corner of your eye), but I guess the inflammation in the lid somehow leaches over to the eyeball itself.. maybe something to do with the nerve endings in the nearby lid being all worked up from the cautery?

So, my point is that maybe it caused allergy season to affect your eyes this year only because they were already peeved off by the roasting of your puncta courtesy of your recent cautery procedure, and next allergy season, they will not be so peeved off (due to a lack of a recent punctal roasting), and will therefore not react to allergens in the air the way they did this year

[DCRdryeye]

Thanks SAAG - yes it's most likely still healing and I'll keep the Zaditen close at hand. Interestingly, I haven't noticed any dripping of tears and still feel rather dry. However, a few times late at night whilst driving, I'd yawn and produce some tears and now since the cautery the excess of tears pools after yawning. The tears sting my eyes, salty tears, very poor quality tears. This happened last night and it was so painful I had to pull my car over and wipe my eyes and wait for it to settle.

I might go back on Cyclosporine drops since it creates better quality tears, I'm reluctant because my 'eyelashes' were elongating and growing in different directions whilst on Cyclosporine drops in the past (located a study in this effect). I have a prescription for Testosterone drops and since they sting on application I'm waiting another month until the cautery is fully healed. I intend using T drops and Optimel manuka honey when fully healed. It's all miss and hit really, trial and error. Oh well, that's dry eye!!

[DianaK]

I had lower cauterization 7 years ago after the punctual plugs became intolerable. Five years ago I moved to California and my condition got worse. The first eye doctor I saw was considering upper cauterization but then I was referred to a cornea specialist who said he didn't think that would solve the problem and got me into a PROSE program in San Francisco. I know the PROSE lens are really really expensive (luckily my insurance partially paid) but they are the only real solution as far as I am concerned. I've had them for over a year now and they have truly changed my life.

[eyes78]

Just wanted to add my 2 cents. I have my lower puncta cauterized several years ago. It made a big difference. A few months ago, a Dr. noticed my right punctum had opened up. Soon thereafter (maybe this was psychological since I didn't notice this until after the re-opening was pointed out to me), I felt like my right eye was really dry. The Dr. re-cauterized it and it felt better after that.

So, for me at least, cautery does seem to help long term.