punctal plug vs cauterisation

[JoolzB]

Hi everybody! I joined the Dry Eye Zone in 2005 but haven't posted for some time.

I suffer from dry eye caused by a combination of hard lens wear in my youth, posterior blepharitis and just plain ageing - my eyes have become drier as I have got older. I am now late 40s and can't wear lenses anymore.

Nowadays I see a dry eye practitioner I found myself, my GP and regular optician having failed miserably to offer me any practical help. Under the care of my dry eye man, my blepharitis is now under control and I also had punctal plugs fitted in my lower tear ducts. Unfortunately the tear duct in my right eye is so huge that the plug eventually fell out and I have had a new one inserted deeper which has the drawback that I can't see it so cannot reassure myself it's still there! I am now wondering if I should go for cauterisation but I hesitate because it is irreversible. Could I ask what others thinK? I kind of feel it would at least mean I could stop worrying that the punctal plug might work its way out again, and as I do still sometimes get days when my right eye can be chronically dry and red even with the plug, I wonder if cauterisation might be more effective.

Any experiences you may have to relate would be interesting to me.

[Jenn1]

Here's some info on cauterisation from a quote made by a person:

Actually the cauterization is of the Puncta, the drains from the eye not the tear duct. the goal is to allow whatever amount of fluid produced by the eye or the tear duct to remain on the surface of the eye rather than drain off into your sinuses through the Punctum.
I have punctal plugs implanted which acheive the same thing. some people can't have them so they cauterize the puncta. there are both upper and loweer drains for each eye. they usually begin by doing the lower ones first.
the topical eyedrop Restasis is often prescribed to stop the inflammation of the Lacrimal glands from which the fluid is produced to combine with secretion of the meibomian glands to produce the tear film of the eyes. some fluid is also given off from the eyeball which can allow for some surface fluid.
I assume you are using lubricating eyedrops both at bedtime and during the day. I use gel type lubricating eyedrops at night and single use vials of preservative free eyedrops during the day as required to help keep my eyes moist so that inflammation of the cornea and conjunctiva does not occur. one can also develop blepharitis, the crusty eyelid problem and if this occurs Doxycicline is used as both an anti inflammatory and antibiotic to treat it. lid hygiene is critical if this develops and usually one washes the upper eyelid along the lash line with a solution of very warm water and baby shampoo. this helps melt the plugs that develop in the meibomian glands and force them out. it is suggested that one instill a lubricating eyedrop prior to doing this to help get the lubricant from the glands properly mixed with the lubricant eyedrop.

[Bill Sonoma County]

Hi Joolz,
Just a quick personal note: punctal cauterization has been one of the key components of my DED treatment. I have MGD, AD, and probably a mucin disorder, and have tried pretty everything except serum drops. Punctal plugs worked for a while but eventually became irritating, scratching my eyes at night, and it wasn't until I exchanged plugs for cautery that I had substantial relief. I think that a lot of us get to the point where the symptoms are so disabling that goofy eyewear, cautery, tear fluid dribbling down your cheek and a pocket full of drops become minor prices to pay. Best wishes.

[JoolzB]

Thanks for the comments, much appreciated. Really useful to get some more info about cauterisation. I don't feel I'm ready to do it yet, but it is reassuring to hear another person's positive experience with it.

[littlemermaid]

JoolzB,

Under the care of my dry eye man

What? You've found one near Oxford, UK?... Would you mind PMing me with the dude's name? I didn't know there was such a thing.

[jadavispcfl]

I had cauterization in both punctals on my left eye, and one one my right. I had a positive experience with both. My doctor actually opened up one of my punctals a little afterward to get the correct drainage on my left eye. I had had two sets of plugs from previous doctors, and both sets fell out.