A question regarding cauterisation...

[SirDryEye]

Evening all,

It has been a long time since I last posted on this forum. My eyes have improved considerably following a procedure for temporary eye plugs (upper and lowers). Unfortunately, my uppers are reluctant to stay in! My doctor has recommended that I get my upper tear ducts cauterised and keep temp plugs in the lowers for now, which sounds like a good solution. However, my doctor also tells me that cauterisation is no more effective than temporary plugs, i.e. I will feel NO more benefit, a benefit that I so deeply need. This contradicts with a common view on this forum that cauterisation IS more effective than plugs (less leakage etc)

Therefore my question is:

Has anyone found cauterisation to be more effective than temporary plugs? My doctor also stated that there are no "permanent plugs", only temps and cauterisation. Again I've read that you can get permanent plugs, but then I'm more likely to be wrong than a highly intelligent consultant ophthalmic surgeon that's been practising for over 20 years. Probably just a misunderstanding on my behalf

HOPE YOU'RE ALL HAVING A GREAT SUMMER

Kind regards,

Sir DRYEYE

[Guest]

Yes, for me, cautery definitely gave me more relief compared to temporary plugs. Your mileage may vary, of course.

I think any doc saying 100% that cautery will NOT be more effective is either inexperienced in treating patients with both of these options (so simply doesn't know any better due to their lack of experience with these particular treatment options), or doesn't believe cautery is a good idea for you (and rather than say so and have to defend their reasoning, they are dodging the issue by saying it won't be any better than what you're already doing... hoping you'll give up and stop asking questions). Obviously cautery won't be more effective than temp. plugs for everyone... but I feel that saying FOR SURE it won't be more effective is not accurate. It would be better to say that it's more effective for some patients and makes no difference for others.

[Member]

Do any of you with 4 plugs/cautery find the extra moisture annoying?

[Guest]

Do any of you with 4 plugs/cautery find the extra moisture annoying?

My eyes are intensely painful and debilitating without cautery. So now that I have all 4 puncta permanently sealed, on those occasions where my eyes are overflowing with tears I'm ecstatic because whenever this happens it means I'm not in pain for that time... it is a WONDERFUL feeling for me.

So I guess it depends on how bad your eyes are without cautery/plugs, know what I mean?

For some people, their eyes are tolerable without blocking their puncta, so the inconvenience of overflowing tears would be super annoying and would not outweigh any benefits. Additionally, such people would probably have MORE overflow than someone like me does, which would also contribute to the annoyance they'd experience.

SO... I can guarantee you that if you dig around, you'll find people for whom having all 4 puncta blocked is amazing, and those for whom it was horrible. Everyone is different. What you need to do is figure out what YOU need for your own situation because odds are you're not exactly like anyone you read about.

If you are certain that keeping your puncta UNblocked won't work for you, then the best thing to do, in my opinion, is to start with a trial of only plugs (if the umbrella-style ones are uncomfortable, then use temporary ones). If that works out well for you and you wish to proceed to cautery (rather than stick to using only plugs), cauterize only the upper puncta to begin, and keep plugs in the lowers (that way if it's too much blockage, you can remove the lower plugs). If that is okay for you, then consider cauterizing the lowers also. HOWEVER, you should assume cautery will be permanent and irreversible - so only go that route if you are 100% sure you're okay with the consequences and your doc has enough experience performing the procedure that you feel you're in good hands. (Yes, technically it can be reversed surgically... but that doesn't sound like a nice procedure to endure, and I don't know what the odds of a satisfactory-to-the-patient outcome are for an attempted reversal... perhaps look into that, but to be on the safe side, assume a worst case scenario where it'll be irreversible.)

re: if proceeding with cautery, why start with cauterizing uppers first?

Okay, so this probably varies from person to person... so ask your doctor. But from what I understand, for most people, the majority of our tears drains out the lower puncta... so if one wants to be conservative, it's best to leave the lowers with plugs since that's reversible if you need to at a later date, and only cauterize the uppers. Additionally - and this probably varies from person to person, so ask your doctor's opinion on this - but in my case the upper puncta openings were angled in such a way that umbrella style plugs would have been rubbing against my eyeball and cause discomfort. So the only option for my uppers that would be comfortable would have been cautery or temporary plugs (replacing them as needed... but a PITA because they won't block the puncta as effectively as umbrella-style ones or cautery... and since umbrella-style plugs were a no-go in my uppers, that left me with the option of cautery)

Why not use permanent plugs that do NOT have the umbrella-style cap? Too risky for my tastes... I don't like some of the horror stories I've heard about those. No plugs are foolproof for horror stories, but the permanent intra-canicular ones without the umbrella-style cap seem to be the riskiest as far as I can tell.

No type of plugs is without risk of issues if you end up unlucky. But I think if one is trying to choose the least risky option that would be temporary plugs, then umbrella-style plugs if a longer-term solution is needed. And if those aren't working out or one simply prefers the risk of cautery to the risk of plugs, then cautery is an option.

[Member]

Okay, thank you for your insight.
I agree, every experience is personal, but it is nice to hear other people’s stories too.

[Member]

I would be interested to know if someone had experience with flow control plugs too.

Thanks for replying.

[farmgirl]

Evening all,

Therefore my question is:

Has anyone found cauterization to be more effective than temporary plugs? My doctor also stated that there are no "permanent plugs", only temps and cauterization. Again I've read that you can get permanent plugs, but then I'm more likely to be wrong than a highly intelligent consultant ophthalmic surgeon that's been practising for over 20 years. Probably just a misunderstanding on my behalf

I disagree with him and I don't care how educated or intelligent he might be. By definition permanent means: "lasting or intended to last or remain unchanged indefinitely". I believe that describes the 'umbrella' type plugs that I have. They will remain indefinitely where they are as long as they are not presenting a problem for me. Before I got the permanent plugs I had temporary dissolvable ones to assess whether or not they would work for me. The temporary ones were only effective for about 3 weeks so that was not going to be an option long term. In the end I had the uppers cauterized and have left the lowers plugged for the reason that SAAG stated.... if I ever recover to the point that I don't need them and find I am overtearing then I would like the option of having them removed. My uppers do not leak but one of my plugs does.

If I was having trouble retaining the uppers and found I was more comfortable with them plugged then for sure I think that is grounds to pursue cautery. I would have permanent umbrella types installed in the lowers.

[Danny_]

Plugs were a good option for me for about 3 years. The trouble was that they kept falling out every few months and I had to go to the doctor and get them put back in. I had this done maybe 10 times before there was a problem. What I didn't know was that every time the doctor was putting them in, they caused scarring. Eventually, what happened was that one of them got stuck in my punctua and the doctor tried for about 2/12 hours to get it out. It was scary as all hell. He didn't get it out and I went to a specialist who managed it. This specialist was great and she also cauterized my bottom two punctua. I don't know how typical my experience was (it was also about 15 years ago so maybe, things have progressed since then), however, there is not much risk to getting the bottom two cauterized so if I was back again, that's what I would do. Just find a really good doctor to do it. It isn't as horrible a procedure as it sounds either. I experienced no pain, just throbbing as far as I recall. Anyway, it's your call.

[LindaDawn]

Am I right in assuming all you above guys posting have aqueous deficiency rather than mgd for which plugs are not advised/recommended/beneficial.