Cautery - is the punctuation closed immediately or gradually?

[tealeaf]

Hi, I have cauterised one of my punctums 2 days ago. This eye has 1 permanent umbrella plug and 1 cautery.However, when I apply drops into the eye, I can feel the drops flowing into my throat, does it mean the cautery is not done properly? Is the cauterised punctum supposed to shut immediately or gradually over the next few days till the healing takes place?

Appreciate your advice.

[tealeaf]

Oops realised the spell check changed the title from punctum to punctuation
in any case, would want to hear advise from people here. If the punctum is not closed, so have to re-cauterise?

[Amanda]

Hi, I have cauterised one of my punctums 2 days ago. This eye has 1 permanent umbrella plug and 1 cautery.However, when I apply drops into the eye, I can feel the drops flowing into my throat, does it mean the cautery is not done properly? Is the cauterised punctum supposed to shut immediately or gradually over the next few days till the healing takes place?

Appreciate your advice.

Hi Tealeaf,

I bet there is not a full seal. I had mine done a few weeks ago and the upper left duct re-opened. I had to go back yesterday to have the cautery done again. Now I'm sporting an awesome black eye from the anesthetic I'm wearing it proudly b/c I actually feel some tears in my eyes! Yay! Let me know if you have any questions about the process I hope you were able to go back to get it recauterized!

[DCRdryeye]

It's a concern when we don't know for sure if the cautery has opened. I've had both lowers cauterized over 12 months now and can't feel any difference, still very dry. Tealeaf, could the drops be getting through the puncta with the umbrella plug rather than the cauterized puncta?

[Amanda]

It's a concern when we don't know for sure if the cautery has opened. I've had both lowers cauterized over 12 months now and can't feel any difference, still very dry. Tealeaf, could the drops be getting through the puncta with the umbrella plug rather than the cauterized puncta?

DCR, I did not notice much difference with just my lowers plugged either. Getting my uppers closed as well made a significant difference (for now). A lot of resources I have read or Dr's I have spoken with say that 80% of tears drain through the lower and only 20% through the uppers. My Dr. Thinks it is more like 50%/50%. I'd have to say that I am in agreement with her, just from experience with plugs! Good luck!

[DCRdryeye]

I also agree 50%/50% is more accurate and yes they do tell us the lower puncta drains 80% of tears but that's not been our experience!! I want to try temporary plugs on my uppers and see what happens, however, I'm going to Peru in 4 weeks and don't want to risk "tearing" there if the temporary plugs retain too much. So I'll wait till I get back in 5 weeks and see what happens.

Amanda were you using moisture chamber glasses? If you do, are you still wearing them all the same after having all 4 punctum's blocked?

[Amanda]

I also agree 50%/50% is more accurate and yes they do tell us the lower puncta drains 80% of tears but that's not been our experience!! I want to try temporary plugs on my uppers and see what happens, however, I'm going to Peru in 4 weeks and don't want to risk "tearing" there if the temporary plugs retain too much. So I'll wait till I get back in 5 weeks and see what happens.

Amanda were you using moisture chamber glasses? If you do, are you still wearing them all the same after having all 4 punctum's blocked?

Hi DCR,

Enjoy Peru! And please let me know how you like it. I really want to take my stepdaughter there next year after high school graduation. She has been going to immersion camps in the summer. My partner (her father) thinks it will be too dangerous, but I know MANY people who have gone and think differently, so we are still trying to convince him.

As for the moisture chamber goggles. I was using these...and I still am using these. Not because I am not retaining enough tears in my eyes, but simply because the tears we do retain we know are not the most "quality" tears. I especially use them outside, but will often use them at work since I am staring at a computer all day!! As for the temporary plugs...I did not have ANY excess tearing with those in (I had the 3 month kind that eventually dissolve). I just don't think they provide as complete of a closure as plugs with a cap or cautery! Please let me know if you have other questions and enjoy Peru!

[DCRdryeye]

Thanks Amanda, yes the temporary plugs certainly don't provide a full closer. The only way for a complete closer are permanent plugs or cautery.

I'll certainly let you know how Peru goes. It's not really dangerous at all, but i wouldn't venture to the border of Columbia or Ecuador. I think you should go next year with your daughter, Peru offers so much in terms of it's rich culture, diverse landscapes (amazon jungle to the sacred valley of the incas in the high andes), ancient ruins, etc. It's also rather inexpensive compared to europe.

[Amanda]

Thanks Amanda, yes the temporary plugs certainly don't provide a full closer. The only way for a complete closer are permanent plugs or cautery.

I'll certainly let you know how Peru goes. It's not really dangerous at all, but i wouldn't venture to the border of Columbia or Ecuador. I think you should go next year with your daughter, Peru offers so much in terms of it's rich culture, diverse landscapes (amazon jungle to the sacred valley of the incas in the high andes), ancient ruins, etc. It's also rather inexpensive compared to europe.

I look forward to hearing about it!!! Enjoy!

[tealeaf]

Thanks all for the replies.

DCRdryeye / Amanda,
my 2 lower punctums have closed up nicely. I suspect the drops were getting through the puncta with the umbrella plug. The eye with cautery and umbrella plug is welling up with tears and I have to dab with tissue few times an hour. The other eye with cautery and 6month temporary plug is still dry. So, I find that temporary plug is not helpful.

Amanda,
Do you have all punctum plugged or cauterised?

DCRdryeye,
Understand that you are using scelera lens, are the lens providing enough comfort? I am going to make a pair next month with Dr Gemoules. My eye doctor finds that post lasik eyes will recover, better not to put in foreign object. What's your tick about sclera lens since you have been using them? Do they cause any problems?

[Amanda]

[QUOTE=tealeaf;96752]Thanks all for the replies.

DCRdryeye / Amanda,
my 2 lower punctums have closed up nicely. I suspect

Amanda,
Do you have all punctum plugged or cauterised?

I have the 2 uppers cauterized and umbrella plugs in the lowers!

[tealeaf]

Amanda,
Do you have issue of overflow since you are quadraplugged? My eye which has umbrella plug and cauterised overflow quite a bit every hour (especially in the morning), that is my worse eye.
I am not too sure if I can put an umbrella plug to the other eye (my better eye). This eye is cauterised on the lower and have a temporary plug, but the temporary plug is not providing enough comfort.
I am in a dilemma as I am using this better eye to see when the other eye overflows.

I hope sclera lens will work for me.

[DCRdryeye]

Tealeaf you have the worst of both worlds there - watering and dry. The latter is always the worse and most dangerous in terms of complications. I've lived with a watery eye for a few years due to a blocked tear duct and did not have "dry eyes" at that stage. Then DCR surgery caused me to flip immediately from watery to severe dryness. So I know how you feel, having both isn't fun. I'd suggest you remove the umbrella plug on the watery eye and possibly have it 'partially' cauterized or try a flow control plug. You may wish to read my blog on the saga I experienced with watery eye: http://www.blockedtearductsurgeryadult.com/

The scleral lens I wear doesn't cause problems until the 5th hour where the lens is aggravating my Right eye. We have not been able to obtain a proper fit with that eye and I've already had up to 8 tweaks over 1.5 yrs...and we'll continue until we get a good fit. If you get a comfortable fit there are no problems with Scleral lenses. I love them and believe they provide the most relief.

Tealeaf I've heard only good things about Dr. Gemoules and he would be my next best choice if I was to travel to the USA for scleral lenses. I'm delighted to know you're planning to see him. We are just as excited as you are about this, please keep us informed.

[tealeaf]

DCRdryeye,

My eye specialist does not have flow control plug and he said is not effective. Not sure if he is right. He keeps suggesting to cauterise my uppers as well. I am not keen as I am putting hope that one day, just one day, my eyes will recover from post lasik dryness.

Maybe I should go to another eye specialist who carries flow control plug.

Do you still put drops in your eye with sclera lens? How often?

[DCRdryeye]

Tealeaf - I've come to believe that what ECP's tell me isn't exactly what happens. We often experience different things and who is to know the flow control plugs won't work until you try them? Eagle's has a flow control plug, perhaps your eye specialist could order them in for you?

An example of what seems right doesn't always feel that way. My optometrist had obtained a scleral lens fit for me that is perfect in all dimensions using the OCT machine. He said the Scleral lens on my RIGHT eye is a "perfect text book" fit according to the images of the OCT machine and he wanted to use the photos for a lecture.

But....did it feel comfortable? Absolutely...not. It's a bad fit in terms with how it feels on my eye. I can't wear it for long because it's so aggravating. Yet I'm told it's a "perfect" fit with the OCT.

On the other hand, the scleral lens of my LEFT eye is not the perfect fit according to the OCT scan...but it is by far the most comfortable fit to me. It's so comfortable I cannot feel it in my eye and can wear it for up to 12 hours.

Moral of the story?... you can't always take their word for it. It's often trial and error with dry eyes.

I apply eye drops hourly with Scleral lenses. The lack of tears will cause friction between the eyelids mucosa and the Scleral lens without enough lubrication. We don't want to develop another problem such as LWE.

I see Scleral lens as a "treatment" too. Since the surface of the eye is total saturated in fluid it's not experiencing trauma from evaporation. The lack of inflammation and irritation is a perfect environment for healing.