I did it! Cautery was finally done

[rkralman]

Whew! I made it through cautery of my right lower duct. I had it done 6 days ago and have gotten along pretty well until today. The experience itself was pretty positive but I do have to say getting shots in the eye to numb the pain was .....yeeeeouch!!!!!!!!!!!!!!!!! But the cautery itself was pain-free and I had little swelling. Got along fine for several days and now today the eye feels gritty and fairly red. Don't know what that is all about.. Anyone else had this procedure and then had a flare-up? Remember, I'm the gal who had 3 plugs lodged in the punctum and had to have them "squeezed" out of my eye, so at this point, I was desperate to try anything BUT a plug, right? Ha! I did have a lot of relief when the plug stayed in place, so I thought that cautery would just be perfect for me...no more hassles and lost plugs down in the punctum. I'll give it a couple more days to see if the eye calms down. Could be a reaction to pollen or something else so I'll hang in there and see what happens. Would love feedback of any other fellow dry-eyers who made the choice of cautery and what your experience was. Also wondering if I might try a temp plug in top duct to see how my eye reacts. My eye is bone dry today, I swear. I don't see ANY moisture in it. Geez! I was praying this would be the answer to my prayers. Thanks for listening!

[Lucy]

Give it more time

Hi..........

Reading through your post and I was thinking you need more time to see what will happen. Your eye could be "bone dry" today and tomorrow overflowing with tears. Then maybe dry a couple of days after that.......

But, first make sure you have no infection going on since your eye is red and tender. With plugs, and probably with cautery, your result with extra tears (or not) does not happen right away. I don't blame you for not wanting anything to do with plugs after your ordeal. Don't get discouraged. Make sure the eye doesn't have an infection, and you'd probably have to visit his office for that. Also, it's a possibility you'd need to have the cautery re-done if it didn't close the punctum entirely. Let us know.

Lucy

[rkralman]

Hi Lucy, you are right...I just need to be patient. The doctor told me that he did not cauterize it too deeply as he left the option to reverse it if necessary. He did say that the punctum tends to want to open back up at times because it is just so unnatural to close it off, so the body tries to re-open it. Just looking at it with the naked eye, it appears to be closed off, but who knows? I go back to the doctor in a week so I'll see what he thinks, but if this stinging and redness doesn't go away soon, I'll get back in there earlier. Thanks for the feedback and I'll keep you updated! Robin

[Cindy]

I hope it works out for you, Robin, and that you're doing better today.

[dianat]

I am cauterized in all four punctae. I guess I'd consider mine successful...no flare-ups or anything. I did have a major reaction to my sister's cats just after I had it done. I assume the allergans were sort of staying in my eye because I couldn't drain, therefore causing the reaction. I'd never reacted to her cats like this before.

Anyway, once I got past that, my cautery was fine.

Diana

[rkralman]

Thanks for the feedback Diana. I called the doc and he gave me a steriod drop for three days to get the inflammation out. Wondering if it does have something to do with seasonal allergies and it is just coincidental that it happened at the same time. Eyes are much better and I'm hoping they keep improving. Do you have much tearing with all four ducts cauterized? Robin

[Amy09]

I had cauterization done in January, and besides Restasis, I think this was the best thing done for my eyes. It took about a month to heal completely, and I had to miss about a week of school, but I would do it again in a heartbeat. You are doing the right think using a steroid drop to help you heal. Just be sure you don't use it more than a few weeks. And just to let you know, cauterization may not be a permanent thing. With chronic dry eye, there is always a chance you can have problems flare up again, and might have to have cautery done numerous times.

[dianat]

If the cautery is done correctly it could stay. Still, I do hear of them opening eventually. Mine has been done at least two years and I'm still closed.

Yes, I do have a lot of tears...in fact, too many. They are not comfortable tears, but they do exist. I still burn much of the time and get excessively dry at night. It's as if my tears are too salty. Nighttime is rough...especially lately.

[rkralman]

Did you happen to read about why tears sting so much even after plugs or cautery? In reading several reports, it seems the "cesspool effect" is very common in that if you do not get inflammation out BEFORE you cauterize or plug, then you'll have the unhealthy tears continuing to float on the eye, causing excessive burning. According to the research, the only way you can get rid of this is with aggressive treatment of a combination of a "low dose or 'soft' steroids such as Alrex or Lotemax, and then add Restasis to this treatment program. The report also talks about if you have stinging with Restasis, you should use the steroid first, wait 5 minutes, and then use Restasis. Stinging is supposed to be almost completely eliminated when using a low does steroid along with it. According to this article, the doctor MUST get the unhealthy inflammed tears under control before any true relief can be noticed and the ONLY way to do this is through long term treatment of several months of low dose steroids and Restasis. Most doctors prescribe steroids for short term, but according to this recent research, the 'soft' steroids are very safe to use for several months until a healthy balance of tears is achieved (combined with several months of Restasis) This research makes so much sense to me..the technical and medical reasons for why this treatment works is in the article. I am taking this article to my doc tomorrow and asking him about it. I am interested to see what his reaction is to this aggressive treatment. My eyes have been plugged on and off and now that I have cautery, I certainly do not want to continue a "cesspool effect" on my eyes. I want to do whatever I can to achieve a healthy tear balance, and if there is even a slim chance I will find relief of burning, I am going to ask for this treatment plan. I'll provide feedback and let you know what he thinks. Robin

[dianat]

Robin,

Yours is the most interesting post I've read in a while. I did try Restasis prior to cautery and hated it due to what I described as a residual all day burn. I read a post in the last week that reminded me of the steroid/restasis trick and added it back into my bag of tricks. I am pregnant right now, so cannot try anything other than regular OTC drops for quite some time. When I am no longer "tethered" to a little one, I'll give it a go.

Please, do keep me/us posted on your progress with this treatment plan.

DianaT - the dry eye patient who blots her eyes a dozen times an hour (at least) but still burns.

[rkralman]

I posted this info last week on another forum here as well as a new member who gave us some really good links. I learned so much from this article and am looking forward to trying something new. It makes so much sense. Many of us have been treated short term with steroids, or many have tried Restasis by itself, sometimes with uncomfortable results due to burning, BUT it seems that the more I research, only those docs who use a COMBINED treatment of low dose steroids and Restasis for several months are seeing fantastic results in their patients. Could it be that we just have not had the right combo of meds or we are being taken off of the treatment too soon? I'll definitely let you know how the doc reacts. Some docs are receptive to new info and some are not, so who knows what he'll say. Only by doing our own research and asking questions can we take control of our destiny against this most troubling phenomenon of "dry eye syndrome" or what I prefer to call Severe Occular Surface Disease, as it sounds so much more important! HA! Robin

[dianat]

Robin,

That was great. Thanks for sharing. Funny is good and we deserve it. Here's the best I can do tonight. It's an oldie, but a goodie...

http://www.dryeyezone.com/talk/showthread.php?t=154

[rkralman]

Update on dr. response regarding combo treatment

Just got back to from eye doctor for follow up on cautery. I came armed with my article and questions on using an aggressive approach to dry eye by using low dose steroid and Restasis TOGETHER to get inflammation (burning/stinging) under control. The doc did agree that the tear has to get a healthy balance to it in order to eliminate the burning, and he also agreed this treatment approach was a great way to do it. His treatment program will be putting me on a low dose steroid drop (Alrex) morning and night. Wait 5 minutes after putting in steroid drop and then add one drop of Restasis. (Putting in steroid first and waiting 5 minutes before putting in Restasis will reduce or possibly eliminate stinging of Restasis.) He was more than willing to listen and agreeable to try this combo approach for a few weeks to see what happens. He agrees that some docs stop treatment too soon or may treat with one med but not the other. The only thing he did not agree on was keeping me the low dose steroid for months at a time. He agreed to a few weeks to see what kind of relief I was experiencing, and then we'll re-evaluate. I was happy with that agreement and look forward to seeing what happens with this. I'll keep you updated. I put the steroid drops in already and I swear I heard my eyes say "AAAHHHHHHH, thank you" !! Robin

[kurt]

The only thing he did not agree on was keeping me the low dose steroid for months at a time.

Long term use of steriods leads to cataracts.

[gudrun45]

I've been on Lotemax for about seven months now, started out with 4x a day and am down to once a day now. My opthamologist does not seem concerned about cataracts. He is concerned about glaucoma and keeps a very close eye on the pressure in my eyes.
When I first started going to this particular doctor, he had just returned from a major conference on dry eyes in New York. He told me the main new thing that he had learned was that some patients would have to stay on a low dose of steroids indefinitely, and that that was okay.
According to him, Restasis will only help certain dry eye conditons, not all. It depends on what is causing the problem.

Gudrun