Cautery

[lilhoser]

Hi, I'm new here. Ironically, I found this site AFTER weeks of online research about punctal cauterization and having the procedure done on my lower right punctum.

I've been a dry eye sufferer (perhaps mild compared to some of the posts I've read here -- I just want to get back to being able to comfortably wear contact lenses) for about 6 years. Before plugs, I tried the standard drops (systane, Liquid Gel, et al), which didn't help and were annoying.

I've had several types of plugs put in my eyes over the years - permanent silicon (various colors), collagen/dissolvable, etc. Since my puncta are not the same size (6mm left, 8mm right) and somewhat large, it has been a challenge of my various opthalmologists to satisfy me. After the last pair of plugs fell out about 2 years ago, I went on a plug hiatus. Last July I had collagen plugs put back in so I could try to wear contacts again (but no success). 4 months later I wanted to try permanent ones again, but as usual, the necessary size had too large of a head on it, and it scraped my eye.

So I decided to cauterize and had the bottom right one done tonight.

My questions are (though somewhat after-the-fact):

1) I've never had a Schirmer test done; I asked my doctor if I should do it and he shrugged it off; I even suggested having it done incrementally over the next few months to measure improvement, but he didn't seem to think it was necessary. Is this unusual?

2) I've never tried Restasis; since I don't do well with drops, and plugs worked for me in the past, I've been advised by all of my various opthalmologists to stick to plugs. But I've been told I can try Restasis if cautery proves to be lacking. Should I have tried Restasis first?

3) I've never had the top puncta plugged; should cautery of the lower puncta prove ineffective, would it be beneficial to first try plugging the top puncta before cauterizing them?

4) There are numerous posts on this forum about cautery, but only a few that share first-hand experience...anyone else (who hasn't posted previously) want to share new experiences?

Thanks all, I love this site, wish I'd found it years ago.

Best,
Aaron

[lilhoser]

Update: Yesterday I noticed a small re-opening in the punctum I had cauterized. It appears the tissue has separated. Based on posts I've seen on this forum, this is not totally abnormal. However, when I called my doctor he said that doesn't happen. Thoughts?

Thanks-

[neil0502]

Hm.

It happened, yet your doctor says it "doesn't happen."

Time for a new doctor.

All the best,
Neil

[Niteyorkie]

cautery

I too had cautery. My doctor recommended it first. I had a trial of dissolving plugs before I went to him. When I told him that and they didn't tear, he went straight to cautery. Which I now have learned is unusual. I haven't had any problems except one time my left eye did start tearing. I went back to him and he said the duct had come open and that my eye was irritated and was watering, he recommended closing it again. This seemed odd to me, but I did what he suggested and closed it again. The tearing did stop. This Feb will make 2 years since I have had that done.
I did try a plug in my upper left puncta. It helped for a while and then my eye started tearing. The plug eventually fell out and the tearing stopped.
This scared me because I thought what if they start tearing and I have permanently closed the bottom ducts. I called my doc and he said that they can reopen the duct if this does happen. It would require surgery. He said that it wasn't likely I would need this as it has almost been 2 years, but it could be opened.
I have to say I have had not problems with the cautery except that one time. After reading about all the problems with some plugs, I am kind of glad I did it. Some people with plugs, have had to get surgery to remove them.
He said I could try Restasis as my eyes are still dry. I am on day 2 and my eyes feel drier so I don't know if I am going to continue it.
Thought I would share my cautery story with you.

[Rebecca Petris]

Hi Aaron & welcome to the forum!

1) I've never had a Schirmer test done; I asked my doctor if I should do it and he shrugged it off; I even suggested having it done incrementally over the next few months to measure improvement, but he didn't seem to think it was necessary. Is this unusual?

Yeah pretty much. Schirmer is a commonly performed test for dry eyes and while it leaves a lot to be desired - methods vary and reproducibility is not good - it's widely accepted as the way to measure aqueous tear production.

3) I've never had the top puncta plugged; should cautery of the lower puncta prove ineffective, would it be beneficial to first try plugging the top puncta before cauterizing them?

If it were me, I would. Seems like there are others here who had overflow when quadraplugged. Some resolved this by putting flow controller plugs in the uppers.

[lilhoser]

Yea, the doctor seemed very astute and helpful at first, but frankly I'm beginning to question his experience (he is in his 50's though). It's tough to find a doctor that has expertise in the entire field of opthalmology, but easy to find ones that are willing to experiment on you and learn...hard to distinguish those two types.

Thanks for the story and comments, I appreciate it. Hopefully I can learn something from everyone's different experiences -- apparently this field of medicine is not an exact science quite yet.

Best,
Aaron

[lilhoser]

Update: After an examination, the doc said the punctum was not reopened, just a small open surface scratch, but the canal itself was still closed (he could not see down it). I just had the other punctum (left lid) done today. Geeze those needles in the eyelid hurt!

We had a small discussion about how frequently the lids reopen after cautery (due to rubbing, tearing, scar reopening, whatnot). He said in over 15 years of doing cautery, he's only had to repeat the procedure on one patient and that was an odd case. Does anyone in this forum have a different opinion based on experience?

Thanks!

[dianat]

Aaron,

I'm quadra-cauterized (I think I just made that term up...) and I've never had anything re-open. I was told many times by multiple docs that often times they do re-open. My guess is that if you have someone perform the procedure who knows what they're doing, you are less likely to have this happen. Should I ever require cautery again, I would be very choosy about who would do it.

I would not be happy to re-live the procedure. It hurt like h***.

Diana

[Niteyorkie]

punctum re-opening

My left punctum reopened about 6 months after I had the cautery. Most likely from me rubbing off my eye makeup. My doctor closed it again free of charge since it had been less than 1 year. I don't remember it hurting that bad. It stung like getting your finger pricked. My doc used 3 or 4 sets of numbing drops 5 minutes apart before doing the procedure.

[LauraB]

cautery of all four puncta and too teary

I have had very dry eyes since I had Lasik several years ago. I have battled with every kind of plug and have been unable to retain most. One year ago I had the bottom puncta cauterized with no effect. After being cauterized on bottom and plugged on top for several months and experiencing comfortable eyes, I chose to cauterize the top puncta. This was almost three weeks ago. Now I have too much tearing and am uncomfortable. I am wondering if this is normal at first and if it's possible that my eyes will adjust. Any advice? I am already thinking of having it reversed.

[dianat]

Laura,

I would most certainly give yourself some time to adjust. It's worth that. I do blot a lot myself, but I've gotten adjusted to it. I know I probably look strange blotting several times and hour, but I'd rather this than dryness.

If you should decide you are ready to open the puncta, do you suppose it is possible to have them partially opened as opposed to totally reopened? It's certainly worth asking.

D

[LauraB]

That's a good question. It would be great to have them partially open. I am trying to give my eyes some more time. I have to remind myself that with all puncta plugged, I was unhappy at first, and then it got better. I am just frustrated with myself. I thought I was making a good decision based on my results being completely plugged. I am a nervous wreck. My eyes are all I can think about.

[dianat]

Go easy on yourself...it's a maddening condition. Try and find eye-friendly distractions...books on tape, exercise, outdoors. If you don't have goggles, that will help with driving and outdoors. Just don't allow your eyes to be the only thing you think about. It's so hard to live that way.

Do hot compresses twice daily. I'm convinced that anyone deficient in tears probably has some meibomian gland/oil issue.

My best to you.

Diana

[LauraB]

Thanks Diana for your advice!!

[Niteyorkie]

Tearing with cautery

I had my bottom tear ducts cauterized. After several months, I suddenly started having tearing. I went back to my eye doc and he said the tear duct had come back open and I was having reflex tearing.
I dont' know if this would be the case with you if it was just 3 weeks ago. How soon did the tearing start?
I had the tear duct re-cauterized and the tearing did stop. Just thought I would share my experience.