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Cautery and no difference.

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  • #16
    Originally posted by Milo007 View Post
    Punctal occlusion doesn't work in the long term since the lacrimal gland down regulates their secretions in response to the decreased neural feedback of the corneal nerves initially after cautery. Initially your ocular surface is flooded with tears following punctal occlusion so the friction between the tarsus and the cornea decreases dramatically. This results in decreased lacrimal secretions over time until the basal rate of lacrimal secretions is restored (which is already less than normal since the lacrimal glands are malfunctioning). So you come back to the same position after a few days or weeks of punctal occlusion.

    Additionally if you have MGD or unaddressed inflammation then cautery can actually cause more accumulation of inflammatory mediators on the ocular surface decreasing the volume of secretions of both lacrimal and meibomian glands due to inflammation.
    Another member who chooses to disagree. I have 2 plugged and 2 cauterized and will never go back and in 8 years have never had a problem, that I am aware of, with inflammatory mediators accumulating. I have also never had to have my cautery redone. It was rather brutal the first time and I think he did a good job as a result. How does that go.... no pain, no gain


    • #17
      Matt0029 should you be blocking your tear ducts if you have inflammation?
      Holding bad tears against the eye is often considred bad practice.


      • #18
        I don't have inflammation at the moment but I think the lack of tears could be causing it my tbut is still low 5 seconds


        • #19
          Originally posted by Matt0029 View Post
          I don't have inflammation at the moment but I think the lack of tears could be causing it my tbut is still low 5 seconds
          oh ok.

          I've been on Salagen for a month now and it's helping me produce tears. It may help you, if you can find a consultant who will prescribe.

          Is it just tear production or do you have issues with MGD, Bleph ?


          • #20
            I had two lower plugs placed in 2010 and, while the right one always bothered me, I persevered since they definitely helped with the dryness. Fast forward to the end of 2018 and the right one disappeared. I'm not sure if it fell out or went down inside the duct. It just was gone. My ophthalmologist put another plug in (different brand) and I just could not tolerate it even after having successfully worn plugs for 8 years! The replacement plug disappeared, too, after only about a week. When the doc tried to put in a third plug, he could not get it to insert into the puncta. And, believe me, he tried! Ouch! His thought was that the second plug he inserted had somehow migrated into the tear duct canal and was preventing him from inserting another plug. So he sent me to a specialist who said leave it alone unless it gets infected. He really did not want to do exploratory surgery to see if there was a plug there. So, bottom line, I don't know if there is a plug in that canal or not.

            I changed opthalmologists and the new one put a plug in the upper duct of the right eye. She was concerned that I might have too much tearing since the bottom duct could still be plugged. That did not happen! I could not tolerate the plug she used and had it removed after 4 miserable, painful days. After a course of lotemax and new eyedrops (Oasis Plus), the eye is feeling better. I'm still trying to decide if I should go back and have her insert yet a different brand of plug. As she explained when suggesting a different brand of plug, she, "can wear Nikes but not Reeboks." Maybe I can keep trying different brands until I find one that "fits"! Guess that could get expensive.


            • #21
              Please help! I have cautery scheduled for Thursday and am scared my eye situation will become even worse. I have no idea how to create my own post on this, I'm a newbie (but have been lurking for years) so sorry if this isn't right.

              Brief history:

              27 y/o female. Symptoms began in 2013 at 22 years old. I woke up one day to extremely dry, painful eyes, and they were dry every single day since then. For a few years I only experienced extreme dryness in the morning, but otherwise they would go back to normal after about 10 minutes of searing pain. Then I moved and my life spiraled out of control, my quality of life tanked, and I was recently so close to suicide that my own thoughts scared the crap out of me. I was at the point where I was putting in drops approximately 250 times per day, approximately every 4 minutes, plus all throughout the night (this has led to extreme insomnia, I'm so so so tired). I lost a lot of friends, could not make any friends in the new place I was living, people stopped respecting me at work because I couldn't have a conversation because I'd always but drops in and was always visibly uncomfortable. My appearance went down the drain - coworkers from my old job wouldn't even recognize me anymore.

              Anyway, both my mom and now my baby sister (she's 25) have similar issues, though thankfully not as extreme. My sister's symptoms are starting out exactly as mine did. My mom's symptoms surprisingly started maybe 6 months or so before mine (we weren't living in the same place, I moved to Boston for my career and previously lived at college), so hers started in her fifties after menopause - but more specifically after she went under anesthesia for an unrelated surgery.

              I digress, I've tried the following: Every OTC drop and gel available, including those from overseas, Restasis, Xiidra, Lacricerts, doxycycline, various steroid drops and gels, Meibomian Gland Probing, goggles, humidifiers, Omega 3s (many types), Flaxseed, Sea Buckthorn Omega 7s, eye drops with and without preservatives, Muro 128, warm compresses (give me a break), cold compresses, I'm quadri-plugged, Tranquil Eyes, Lid Scrubs, Acupuncture, went to a consult for PROSE - they said I wasn't a candidate (that's a different, laughable story), Clindamyasin, Vitamin A supplements, Ox bile to help absorb Omega 3s (I had my galbladder removed when I was 18 due to a severe infection brought on my mono - I was in great shape, 5' 6" and 119 lbs - doctors were amazed - that's a different story though), I do organic coconut oil washes every night and use diluted tea tree oil on my lashes and also use Xiidra at night which keeps my eyes completely closed. I'm now on the Autoimmune Protocol and have been for about 10 weeks now, it's crappy but I think it's actually really really helping - I'll write a post once I can figure out how to do it. Tested for Sjogrens and other auto-immune conditions and they were all negative. Oh, I also was getting Staph infections all the time (my legs below the knee are really scary to look at) and I was also itchy everywhere all the time. Both those issues have ceased since a few weeks into AIP (something I always thought was quacky and dumb).

              Anyway, my upper plugs fall out ALL THE TIME and it's killing my time, my job, and my wallet. I have cautery lined up but I'm wondering if I should wait until after my wedding in 5 months to do it - I finally finally finally have been having more long term significant success (again, I'll write about it, it's extremely long and complicated) and am worried that I'm going to be miserable at my wedding due to my issues. While vain, I would love to wear contacts and eye makeup for just a couple of hours for the wedding, and am worried that I won't be able to - I have way bigger fish to fry (like the fact that we probably can't have children in the future because I can't even take care of myself), but still something to think about.

              PLEASE HELP! What has your experience been with cautery? Please tell me if you have uppers, lowers, if you have paired with plugs, and how long you have been plugged for.