Decision to make. Need info...

[Kyle]

Okay, I need advice. A lot of you know I went to a specialist last week because my two top docs couldn't figure out why my left eye was bleeding from the corner near my bottom tear duct. They sent me to a eye surgeon whose specialty is actually plastic surgery (???). After looking at my condition he too couldn't quite figure out what was wrong (nice, huh?) He saw an open sore, but doesn't know why it's there, what's causing it or how to correct it. He advised me to keep using drops, warm compresses and to put erythromycin in the corner every night before I went to bed. He also told me to finish using my TobraDex, but to stop after a week because he said it could cause serious eye problems (gosh, I thought that's what I already had!)
He wanted to flush my tear duct canal and flush out the van herrrick plug because he said he thought it was infecting my canal and possibly pushing through causing the sore and the blood. Here's the catch..he wasn't sure that was the problem that was just his guess. He actually went back and forth about what to do and then I asked "what would you do if it were your eye?" He said he would wait. He told me that the van herrick plug (I think I'm saying that correctly) was a bad plug to use because it was permanent and nothing could really be done with it after it was inserted. He advised always using temporary plugs, but I told him my eyes always pushed them out.
He said if my eyes don't clear up (which they haven't yet and it's been a couple of weeks now) he wants to flush the canal and then catherize my tear ducts.
What do you all think? What are the advantages of catherizing my ducts compared to just plugging them? Any down side to catherizing them? Anybody had any complications with that? Any good relief from it?
I hesitiate to do ANYTHING else to my eyes, because it always seems to be the wrong thing. All of you seem to know more than any of the other docs I have been to so I really, really want your advice.
I'm also thinking of heading to Boston where I hear there are some really, really good specialists. Anybody know of any there that would help?
I'm really at my wits end. All 3 of the docs last week were amazed that I could actually push on my tear duct area and have blood squirt out of my eye. They said they had never seen anything like that before. Trust me, that doesn't make me feel good!
I'm really trying to keep my spirits up, but it's not easy. It was actually nice tonight to watch the salute to our troops and get my mind off of my problems. They have it SO much worse than me and that made tonight easier and made me get up and e-mail everyone here.
Any suggestions/help would be appreciate.
Thanks!
Happy 4th!!!!

[dianat]

Kyle,

I've been wondering about you a lot lately. I can understand your frustration and fears. Could it be worth getting another opinion? Why did you go see a surgeon whose specialty is plastic surgery? This makes no sense to me. I assume the LASIK docs referred you. Please consider another opinion...someone else must might be able to identify with your symptoms...like an opthalmologist who specialized in diseases of the eye, or eye ulcers or herpetic sores or something. (I'm a lay person, bear with me.)

Having said all of that, I don't entirely disagree with your doc's recommendtion. Maybe you shouldn't be wearing plugs. It does seem you've had a lot of trouble with them. Cautery just might be the way to go for you, but why not see how you do flushing out the ones you have and giving yourself time to live with what you have for a while. Perhaps you'll decide not to have the cautery done. Perhaps you will. Either way, take your time deciding.

In the meantime and before you make any big decisions, see someone else.

I am anxious to see what your other friends here recommend to you. Hang in there. You will get past this.

Diana

[jcorbett]

cauterizing

I aggree with Dianat. I would concentrate on getting this cleared up first and then worry about cauterizing. You are only at the six month period after Lasik. Your dry eyes could improve enough where you do not need cauterization. I would imagine this infection is making your eyes feel much worse as far as the dryness goes, so see how your eyes do once this is taken care of. I believe there are different ways to do cauterizing....some can possible be reversed.
The plastic surgeon doc.....he seems to know a lot about eyes, though. He said he always recommends plugs, and wants to irrigate the canal. That sounds more like an eye doc???? Did the first docs you saw mention irrigating the canal to get the plug out?
My guess would be that the original docs think the plug is still in there, and sent you to the plastic surgeon/eye doc because they were not sure how to get it out. Did your plastic surgeon doc mention possible surgery to remove it?
Did he say why he didn't want to try and flush it right away? Because of the infection?
How long does he want you to wait?
Perhaps this doc could recommend someone for a second opinion? It is so frustrating when doctors don't agree or don't know what to do. We want them to be gods and tell us exactly what is wrong and how to fix it. Makes me wonder how we ever listened to them in the first place!!!
I'm glad you wrote. I was wondering how you were doing. Hang in there.

[Chris]

Kyle:

I didn't realize you were only 6 months after surgery -- more tears came back for me between 6-12 months after surgery. Personally, I would not do anything permanent, like cautery, that soon after surgery. If you did cauterize, only do the upper or lower, not both.

I have had Herrick plugs in for three years with no problem. From what I understand from one of my eye docs (who does not like Herricks), the plug can turn and get lodged in the tissue causing bleeding. It may take some flushing to get that Herrick out of there (brace yourself it's not fun, I've had it done). There have been cases where surgery was necessary to remove the embedded plug.

This eye stuff is such crap and can be so hard to deal with. I hope you can come to a decent outcome. Good luck. We're thinking of you.

Chris

[Kyle]

Thanks for all of your responses. I actually pulled the drs card and it says "ophthalmic plastic and reconstructive surgery"
I think it's just like one of you said....my drs thought the plug was shifting and not in there correctly so they thought it needed to come out. Yes,they did mention irrigating the canal, but they couldn't agree that it was the plug causing the problem. The one dr said he actually could see the plug sticking out a bit (he was the clinic director), the other dr couldn't see it. The specialist said he too couldn't see it, but not liking the plug itself, he didn't see any harm in getting it out. That area of my eye is actually swollen and I often wonder if that plug has somehow turned. Because the specialist couldn't actually tell what was going on and was hesitant to do anything, I agreed to wait. I do agree with ALL of you..I think I should take it out and then see what happens. I'm just scared that somehow it'll cause some other infection. They all said it's possible there is a lot of bacteria and scar tissue behind the plug and it could go into some other canals (nose, ear, throat) and cause various other problems. Does that sound right?
And Chris, yes that is my other concern. I really, really don't want to go through any other pain or discomfort and the way he described the procedure it didn't sound fun.
Right now I'm still at the "wait and see" phase. Nothing seems to be changing though and I'm supposed to call him this week.
I might see if anyone here can suggest yet another dr, but honestly I'm so sick of the drs around here I thought I'd fly out to Boston and see what they said there.

[Rebecca Petris]

I do agree with ALL of you..I think I should take it out and then see what happens.

It certainly sounds like there is greater risk in leaving it in that in taking it out. If it were me... I don't think I'd hesitate. Even if there weren't 100% certainty about the specific cause, the probabilities sure seem to point that way. And in medicine so often there is not going to be 100% certainty or 100% agreement amongst doctors about anything.

In any case I'm sorry you have to go through this and hope it gets resolved very soon! The "wait and see" approach to cautery also sounds like it makes sense.

[mary kenny badami]

Hello, Kyle!

I don't post often on Dry Eye Talk, but I read here every day, and Rebecca and Cindy (and perhaps others) can vouch for my good intentions. I've been very concerned about you. I'm just another patient, post-Lasik, who both before and after Lasik had more than a few plugs inserted/ embedded, one of which may or may not still be embedded there, several of which definitely fell out, and two of which I took out myself (I called my eye doctor at 10 pm one evening after experiencing terrible pain and said, "I flicked that f*cker out").

Here's my advice:
1. Yes, get that plug out. It might be the culprit, but even if it isn't, you won't know until you get it out.
2. Ask for appropriate medicines, especially including pain relief, while your eye recovers from the trauma of the plug removal.
3. Thank the surgeon for his/her concern, but insist on waiting for a while after the plug is removed to assess how your eye recovers from the procedure, to have your tear film re-analyzed once the plug is out, to learn more about cautery, and to decide whether you want to undergo cautery.
4. Trust that ophthalmic plastic surgery is a real specialty. Several years ago I consulted one such doc concerning cautery for myself (I decided against it). Last month while visiting my son in northern Virginia I met one of his friends who is an M.D. in that specialty. She says that about one-third of her practice is "cosmetic" (tightening flabby eyelids and shoring up pouches under the eye to improve appearances), but that the rest of her practice consists of helping people recovering from injuries and diseases including cancer, and that her expertise includes seeing that people's eyelids and glands and puncti are working as well as possible after their original problems, especially concerning tear drainage and functioning of the eyelids.
5. Boston? Why Boston? Why travel at all from home? At what expense? I know that you are frustrated, but ($$$$speaking as someone who has left her home region seeking relief at $$$some major expen$$$$$e) I would caution against spending the money to leave one's home region unless there is a caring doctor who has previously reviewed your case (for which you might have to pay a legitimate fee), and who proposes some credible ideas about how they are prepared to help you.

wishing you well,
mary

[Kyle]

Thanks Mary. You actually had me laughing with the "flicked that f--out" line!
I know how you feel. I swear I am constantly looking in my 7X mirror and thinking I'm just going to get my tweezers and pull out whatever is causing me the new problem. I can't see it..thank God, because I know I'd be tempted to do it.
Boston was only an option because my Dad lives there and I know they have really, really good doctors there. I think it was really just a change of venue I was looking for. Nobody here (LA) seems to have any answers for me..and I'm really just looking for that...qualified answers.
The info on my new specialist was good too...thanks. Gives me a little peace of mind.
Okay, here's my question for both you and Chris (and any others)..and please be honest....does it hurt to have the plug pushed out? If so, what level of pain is it? How long does it hurt? I think I've reached my threshold so I'm just asking so I can judge when I should have it out.
Oh, new development today, not a big deal really, but adds to the whole problem. The eye area (the skin) around the tear duct that's infected has now developed spider veins all around it. Goes lovely with the red, broken blood vessels inside my eyes though. I'm thinking now I should shift my career options to just horror movies...what do you think?
Seriously, thanks to all of you for the well wishes. Now, if life could just get bearable again, I'd know those well wishes were working!

[Cindy]

by Kyle:

Okay, here's my question for both you and Chris (and any others)..and please be honest....does it hurt to have the plug pushed out? If so, what level of pain is it? How long does it hurt? I think I've reached my threshold so I'm just asking so I can judge when I should have it out.

I don't know if it hurts to have the plug pushed out. I had my puncti flushed/irrigated to see if my Herrick's were still present. Presumeably the irrigation would have forced the plug(s) out. My right eye was free and clear of obstruction so the Herrick plug in that eye was gone. My left eye Herrick was still there (somewhere, imbedded and still obstructing the canal). The whole flushing/irrigating gig did not hurt. My punctum was dilated, a tube inserted and saline forced through. Saline rather suddenly goes down your throat, into your nose and feels like it's coming out your tear duct. It's no big hairy deal compared to what you put up with every day. I snorted, coughed, was not very ladylike but I had no discomfort afterward. The doctor walked me through it every step of the way and even handed me tissues on cue. He knew exactly what I'd be feeling and when I'd be feeling it.

If I were you (which I'm not) I would have my punctum flushed to see if there is an obstruction. If there is, then you and your doctor will know that the Herrick plug has likely migrated and may be an irritant and the cause of your bleeding. The next step in my very, very humble, layperson opinion, following irrigation of the punctum and if that shows there is an obstruction, would be to have the Herrick plug removed. That's what I would do. Get the f*cker out.

[dianat]

Quick question: is the blood coming from your punctum or a sore near your punctum?

[Kyle]

That's the thing...it's coming from a place near the tear duct hole, not the hole itself. I think that's why they are confused about what is going on.
Cindy, your description of what the irrigation would be like is exactly how my dr. described it. He did say he thought there was probably bacteria and possibly scar tissue behind the plug and that could go into other canals (ear, nose, throat) and cause other possible problems, but hopefully it would all "come out in the wash".
Thanks for explaining it all to me though. It sounds pretty simple. I still might ask for a valium or something. I start hyperventilating everytime anyone goes near my eyes at this point. When anyone pulls that left lid down my eyes rim with blood and I immediately feel like I'm going to pass out. I'm such a wimp now and I use to think I could handle anything...ha!
Cindy, what do you have now in your eyes? Another plug?

[Chris]

Having the plug flushed out was very unpleasant. It took a while for mine to come out (on the upper). I was sore that evening. Like Cindy said, nothing we haven't experienced already though.

Good luck!

[dianat]

If you need Valium, then you need Valium. I have a lot of anxiety when I see eye docs or have a lot of pain in them. This has been so horrible for all of us, it's understandable how it affects our psyche. I sometimes worry about seeing my LASIK doctor in public because just his presence would no dout trigger a panic attack.

I still think a second opinion is important. I've looked for eye docs before and have sort of "prescreened" them just by talking with their staff or receptionist on the phone. It's totally appropriate to express your problem with someone on the phone and ask for their honest opinion whether their office can offer that level of expertise. Unless you absolutely need a referral, forget who the LASIK surgeons recommed.

I've often told receptionists who answer the phone that I'm looking for an eye doctor who (in addition to dry eye expertise) is also patient, understanding and who, frankly, will give me the time of day. I've been very fragile the past few years and these are crucial to my care...nearly as crucial as raw medical expertise.

You might also hope your doctor has a sense of humor so when you tell him/her to, "take the f_cker out!" he won't be too offended.

[Kyle]

Diana,
I actually replied back to you this afternoon with a l-o-n-g e-mail, but when I hit "send" it deleted my message! I really wasn't up to re-typing the whole thing. I'll send it to you personally because it was the story of how I did run into my lasik surgeon out in public. Very ackward, but I think I got the upper hand...in a very devilish, sugary-sweet kind of way!
Today was a really bad day. I actually slept almost 14 hours (my eyes don't hurt when I sleep)..and then I woke up thinking "great, my eyes should be SO refreshed!" No such luck. They are actually drier than usually and red and bleeding. I'm going to take your advice and pre-screen some drs tomorrow. I'm only hesitating calling the specialist tomorrow and getting the plug out because even he wasn't sure that was what was causing the bleeding. I really, really don't want to aggravate my situation even more by doing the wrong thing.
I'm going back to bed now. My eyes are perfect in my dreams!

[dianat]

I think of you often, Kyle. Hang in there. I know you'll get past this. There is an answer out there.