What is "backup inflammation?"

[No tears in ATL]

Having top ducts cauterized next week and doc prescribed steroid drops to "cool down" inflammation. He said he wanted to avoid "backup inflammation." I'm confused. I've never heard of this term. I should have asked but unfortunately he spent all of 7 minutes with me. ALL steroid drops actually make my situation worse, so I'm not taking them at this time. I am taking the day off prior to the procedure as to get proper rest and I've found that ice packs can cool the redness down better than steroid drops and I don't get the endless burning.

If worse came to worse, we could try smartplugs (ugh--I've read about how annoying these can be) or I could put off the procedure. Overall I find my eyes are under better control without the use of any drops, just good old rest, staying out of A/C and avoiding computer.

[spmcc]

Hello ATL,

I'm sorry - I've never heard of "backup inflammation". However, regarding steroids, it is probably the preservative in the drops that makes you worse. Definitely 'demand' preservative-free steroid drops to get the inflammation under control.

As for cautery, I love mine. I have all four puncta sealed (three cauterized, one sutured). Having all four puncta sealed and wearing moisture chambers 24/7 has taken away the worst discomfort and pain from my dry eyes.

Yikes is what I say to smartplugs! Years ago I had intracanalicular plugs in the lowers with no problem (but no improvement either). A year later, I got intracanalicular plugs in the uppers. Presto - instant canaliculitits! I spent 4 months with goopy eyes that the doctors swabbed 3 times to culture (nothing grew). Normally I have no gunk in my eyes - no tears, oil or mucus - dry as a bone. But with smartplugs you could "milk my puncta" (push lightly on them and white liquid would come out). Finally I got all four flushed with saline and vigamox, was put on vigamox drops, and, phew, the crazy goop was gone and has never returned. Now I realize that I was one of the lucky ones wrt these plugs.

As for forced air heat, a/c and computer use, I highly recommend moisture chambers to help you with all of these things. Check out Rebecca's guide to moisture chambers.

Just a few questions though - do you have a 'real' diagnosis? I know you mentioned AD. Have you been tested for Sjogrens?

Good luck with everything.

[No tears in ATL]

Thanks for the feedback, spmcc. I have had the Schirmer's test, and although I can't remember my score, I think my tears evaporated within 1-2 seconds. Doc said tear quality was good, however. The oculoplastic surgeon who does cautery has my chart and everything, and his response was "wow, you've got REALLY dry eyes." The steroid drops they gave me were preservative free-- the name is durezol--and it still feels like acid on my eyes even when I put lubricating drops in beforehand. Castor oil, however, is in these things, and that stuff is way irritating.

I have not been tested for Sjogrens. Is there an oral cyclosporine used to treat it? I only wish I could wear goggles at work (they keep the A/C on 69! That's NOT normal!), but I'm a little self conscious I guess. It's a pretty uptight, conservative environment, and frankly, I'm thinking hard about another line of work related generally to the field I'm in but with less computer use. At wit's end.

Oh, appreciate the advice on smartplugs. Wow, I knew these things were bad, but looks like they are trouble waiting to happen.

Hope you are having a good weekend. I'm so glad the cautery worked for you!

[No tears in ATL]

Wait. Just looked at package insert again. This steroid drop comes in individuals vials (just like restasis) but is preserved with .1% boric acid. Not sure if that makes a difference, though.

[poppy]

Some docs say that you shouldn't plug until inflammation is calmed down. That is because once the tears are trapped on the surface of the eye for longer (with the inflammatory cells or whatever the correct term is), it can cause further inflammation, which makes your eyes even more dry... I think that is what your doc was talking about.

I would try to find out whether the steroid drops are helping (from the docs perspective) because if they are it is probably worth trying them some more. When your eyes are really bad putting anything in them even artificial tears can sting... but long term might still help. I find the preservative free steroid minims are more comfortable to apply, although I don't think they actually "work" any better.

[spmcc]

I find the preservative free steroid minims are more comfortable to apply, although I don't think they actually "work" any better.

I agree with Poppy. I would try to get something like Minims Prenisolone 0.5% sterile single dose. In my opinion/experience, the "right" steroid drop shouldn't sting. The backlash you can get (of dryness) is due to the preservative if there is one. But I think that your doctor is probably steering you in the right direction to reduce inflammation with topical steroids (for now).

Good luck.

[No tears in ATL]

Oh, thanks! I had never heard of completely "preservative free" steroids, per say. I will ask my doctor about the brand you recommend.

[eyemech]

Just posting to test the system.
I think many of you should consider having the superior puncta plugged rather than the inferior. That filthy water has to go somewhere. It reminds me of the last person in the wild west taking a bath on Saturday night.
Calming down..great idea, but you can hardly keep it calmed down from this day forward.