Comments on stent in NLD?

[Rebecca Petris]

Anybody here have a stent due to NLD obstruction... on a dry eye? Comments on good/bad experiences?

I don't like messing with procedures of any kind if it's possible to avoid them but getting desperate enough that I might have to. Left eye is sitting in a puddle by day and bone-dry, fragile-to-the-point-of-erosions dry at night. Been cycling in and out of canaliculitis and other crap, can't wear PROSE/scleral, can't see, yada. So really have to get off my rear and stop ignoring it pretty soon. Just would appreciate hearing from someone who's had a stent in reasonably similar circumstances. The eye with the blockage is actually my 'good' eye, dryness-wise, normally.

Much appreciate input

[peter56]

Hi Rebecca,
single case experiences are not always very helpful.

So here some studies containing reliable statistics and it seems the success rate is high.
I can't mail the full texts here.

http://www.ncbi.nlm.nih.gov/pubmed/22566177

http://www.ncbi.nlm.nih.gov/pubmed/23931476

http://www.ncbi.nlm.nih.gov/pubmed/22384944

http://www.ncbi.nlm.nih.gov/pubmed/20564733

Do you have no Bandage lenses at hand for some days to prevent the irritations?

[Rebecca Petris]

I appreciate your input Peter. I am aware of the studies though... I spend a lot of time (well, I used to anyway) on pubmed too.

But what I am asking for here is real life individual patient input.

[DCRdryeye]

Blocking of the NLD can certainly be caused by dry eye. However, it would act like a punctal plug and assist in retaining tears. The problem is the tear sac pools with tears and becomes infected. The stent you're referring too is not the bicanicular stent used after DCR surgery but a stent placed directly into the Nasal Lacrimal Duct, such as explained here:

http://www.ncbi.nlm.nih.gov/pubmed/12130461

I also mention the procedure on my website: http://www.blockedtearductsurgeryadult.com/?p=156

The success rate is about 60%. I wish I would have found a surgeon to perform this procedure on me rather than the DCR. I wouldn't have half the problems I do now. Indeed, I've spoken with many people whom have had the procedure via my website and results have been mixed from successful to painful and wanting the stent removed. The positive thing about the procedure is that it doesn't change the structure of your Lacrimal system. If you are unhappy with it, or if it re-stenosis after removal...there's no harm done. It's not a risky procedure.

[peter56]

Hi Rebecca,
I am sorry I didn't know, that you do have available the full text articles.

The main probleme is, that in the canaliculi there are nerves of the neuronal tears reflex system.
If there are going a lot of tears - artif tears through these canaliculi, the system does down regulate
the tears production of the lacrimal glands.
So if these nerves are being damaged during the surgery, the system can get into disorder.
I do know of two patients, that do have a much lower tears production after the surgery.
Also in two older studies they are mentioning these problemes.
If eyes are very dry anyway, These problemes don't matter much. But as you will know, for soft and scleral
lens wearers every mm of schirmer is most important.

[Rebecca Petris]

DCR, thank you. I had seen earlier post of yours about it and figured I'd probably hear from you Otherwise there are very few mentions of stents on DEZ though. Was just trying to dredge up some real life experiences. We have so many on practically everything else - Unfortunately (sort of?) this blockage happened to my 'good' eye that actually has quite a lot of aqueous tear production, and the resulting chronic infections are nasty. Pain biggest issue though, can't use computer for long = can't work.

Peter, thanks, actually I don't have access to most full text studies... I just meant that I browse the abstracts and I can usually get the full thing if I'm interested enough. (Kneejerk response to seeing link posted when I can't read for very long .) I appreciate your mentioning those patients - good to know. In a sense I suppose I can "afford" to lose a bit of tear production in that eye. It is not all that dry. It is my non dominant eye, and it's also rather flaky in general anyway (I have intermittent GPC and other problems) so I was always periodically unable to wear a scleral for a few days here and there anyway.

On the other hand I am so reluctant to consider eye surgery in general that it's taken six months of pain and infections to get me to even think about it! I guess I've been gradually migrating from "better the devil I know than the devil I don't" to "I really have to do something and there doesn't seem to be anything else left to do". It's been a good 10 years since my eyes were interfering with my life this much. Thanks again both of you for the input.