lacrimal gland ductule obstruction

[colibri]

Hi everyone

just wanted to share a treatment that worked for me. Like many of you, I regrettably had LASIK 7 yrs ago. I remember when the surgeon inserted the speculum in my left eye I experienced pain in the superior lateral part of my eye. He basically jammed it in there as it was too large for my eye. Recognizing the error, he then changed the speculum size. Following the surgery I had unilateral dryness in that eye and about 3 years later developed full blown dry eye syndrome. I had always speculated that the surgeon had damaged the tiny ductules that carry the tears from the lacrimal gland located just above the eye. This is NOT a widely accepted complication of eye surgery in the opthalmology community but certainly possible since those speculums are sharp steel objects. This may explain why about 4% of pateints undergoing ctaract surgery end up with dry eye although their surgery is minimally invasive. After seeing one doctor after another I found a link on the web to an occuloplastic surgeon in Florida who did his dissertation on the possiblity of lacrimal gland obstruction causing dry eye. He had hypothesized that probing the ductules could relieve the obstructions. I had tried all the standard treatemnts including Restasis, plugs etc. I finally convinced a occuloplastic surgeon near my home to probe (with a 30 gauge needle) the ductules in my left eye. CURE! My schirmer test in that eye went from 3 to 10. After a year I was still feeling a little dryness and I asked him to repeat the procedure making sure he got all ductules. My symptoms of dry eye are NOW GONE! So if you have unilateral dryness and recall pain when you got the speculum placed during LASIK or other eye surgery this may be the soruce of dryness. Be prepared to convince a skeptical occuloplastic surgeon but the actual probing is an office procedure minimally invasive done with topical eyedrops.

Good Luck!

[dianat]

Good for you! Where do you live and who was your doctor?

[IanJ]

Hi,

Fantastic!........

Do you think that the ductules could become blocked outside of any LASIK.....i.e. could it happen on it's own...and possibly overnight?

Ian.

[cat2103]

I would really like to find out more about this. Can you point out where on the web the dissertation you referred to can be found.

[Rebecca Petris]

If the only way to pursue this kind of treatment (if that's what it is) is by convincing a skeptical surgeon in his very own area of expertise, I would be extremely cautious of pursuing anything of the sort. If this is legit, there ought to be medical literature about it and active practitioners doing it. I will see if I can find out anything more.

[colibri]

Hi,

Fantastic!........

Do you think that the ductules could become blocked outside of any LASIK.....i.e. could it happen on it's own...and possibly overnight?

Ian.

The conventional wisdom regarding Lasik is that the corneal nerves get severed and don't grow back. Therefore, the eye cannot tell the brain and the lacrimal gland that it needs tears. One opthalmologist I saw said that approximately 4% of patient who have undergone cataract surgery get dry eye. The incision made in cataract surgery is typically miniscule so the corneal nerve model does not explain dry eye resulting from ctaract surgery. The speculums used in any type of eye surgery is pretty sharp so theoretically, if poorly positioned they could cause lacrimal ductule obstruction in any eye surgery.

[dianat]

What doctor performed your procedure?

[calli66]

Hmmm--that's interesting--about the eye speculum use. I had surgery on my sclera--my right eye--in 1987, and I remember a device like that. Since then, my right eye has always been much drier than the left.

Calli

[colibri]

If the only way to pursue this kind of treatment (if that's what it is) is by convincing a skeptical surgeon in his very own area of expertise, I would be extremely cautious of pursuing anything of the sort. If this is legit, there ought to be medical literature about it and active practitioners doing it. I will see if I can find out anything more.

The Dr. who posted the dissertation report online was Dr. James C. Sanderson in Palm Harbor Florida. I believe he has changed the location of his practice and in doing so had to close his web-site so I have not been able to find it again online. I had spoken to his office a while back and I was informed that he does this procedure,however I do not have a current number for him. I have done extensive research into the medical literature on this and have not found any peer reviewed articles describing this procedure or postulated etiology. As implausable as it sounds, it is quite possible that this source of iatrogenic morbity has been overlooked by the experts. All I am doing is sharing my experience as a patient and my experience as a medical researcher.

[Rojzen]

absolutely brilliant

Colibri -- I find your ingenuity in this to be absolutely brilliant, and something we should not fear emulating. Your scientific mind made you wonder about the speculum's possible effect on the ductules, and your determination led you to a scientifically-inclined doctor who concurred sufficiently to attempt the probing. Given that the doctor was expert in ductule function, and had probably done lots of hands-on tinkering with the tiny-gauge needle, I would not personally consider the procedure to have been any more risky than some other procedures that are standard practice today.

May I share, in this regard, that I once experienced prolonged deformity (I thought it would never go away) caused by an extremely forceful meibomian gland expression procedure. The ophthalmologist who performed it had published about the procedure, and was doing it for many patients. Today, moreover, fairly forceful lid expression is gaining wider acceptance daily. Anyway, the doctor exerted tremendous pressure on my eyelid, until some old metaplasia tore off, and some secretion resulted. One area of my eyelid reacted with swelling in the form of a hard, little ball that then scratched my ocular surface constantly, for months. I had to wear a bandage lens just to protect the surface, 'till the swelling miraculously subsided, maybe 4 months later. Needless to say, I shall never seek lid expression again.

Anyway, I'm all for lots of replication in science, but sometimes procedures are simply not fraught with terribly great risk, and perhaps these should be tried, even prior to extensive testing. Conversely, many already-replicated procedures still have kinks (like that awful lid expression I had), and should, perhaps be scaled back.

Anyway, I'm thrilled you have found a cure. Thank you so much for sharing this!