Don't get probed

[DCRdryeye]

The doctor who was supposed to do the "partial cautery" on 9 December cancelled me as a patient and thus the surgery didn't go ahead. He cancelled me because I simply asked a question and he didn't like his methodology questioned. Firstly, he wouldn't speak to me on the phone, where we could have easily sorted out my question. Instead, he rather spoke through his assistance via email. That's no way to communicate and thus he didn't like me asking the question - "I was assuming you're reducing the size of both upper and lower puncta, I now hear you're only doing one? Why are you not cauterizing the upper puncta too?"... is that such an offensive question to ask? Is it offensive enough to dismiss a patient? How disgusting. He cancelled me as a patient via an email he wrote himself suggesting the 'doctor/patient' relationship has been breached. Absolute rubbish!! He just gets rid of all patients who dares question him and could possibly provide negative feedback. What's scarey is that this Sydney doctor is so highly regarded as a DRY EYE SPECIALIST, and commenced the 'only' dry eye clinic in the country. Yet, he doesn't have LipiFlow, doesn't do Probing, doesn't have a Meibography machine and only seems to work with steroids and believes inflammation is at the core of dry eye. Oh...and he also does LASIK. Perhaps he was busy creating a new dry eye patient by doing a LASIK procedure and thus couldn't phone me?

Later, another, more prominent ophthalmologist said that no-one can guarantee a partial cautery, there's the possibility of permanency. However, the following study did partial cautery with accuracy....

http://www.ncbi.nlm.nih.gov/pubmed/21591859

So it can be done. My next task is to find someone willing to attempt it, or devise a way to cauterize that's not permanent and can be reversible in the future.

I didn't waste my $500 flight ticket for the cancelled surgery. Rather I booked in to have Meibography and LipiView done (we don't have those machines in our capital city of Melbourne - it's insane). The meibography revealed no gland drop out on the right eye, and partial drop out on the left eye (the left eye is always the worse, and the eye with the enlarged punctum's from DCR). The Lipiview showed my lipid layer is not too bad, but 10 times out of 10 I do not fully blink (thus partial blinking is not pumping the meibomian glands to release oil).

My views on Meibomian Gland Probing has changed. The doctor whom cancelled me as a patient 'used' to do Probing, but since his patients didn't receive the results, he stopped it. However, that's not a reason to stop and PROBING IS NOT THE REASON FOR A LACK OF RESULTS. In my case, the blocked ducts needed to be probed, and although the meibum is now free to flow, the lack of a full blink is preventing the meibum from being secreted. I was issued with blinking exercises, purchased a BlephaSteam and will gently express my glands.

Since the optometrist could easily express my glands with his fingers with copious meibum secreted, and as evidenced by LipiView, he suggested against LipiFlow. He also said the main priority is to occlude the Left eyes punctum's.

[NotADryEye]

Perhaps he was busy creating a new dry eye patient by doing a LASIK procedure and thus couldn't phone me?

Later, another, more prominent ophthalmologist said that no-one can guarantee a partial cautery, there's the possibility of permanency. However, the following study did partial cautery with accuracy....

http://www.ncbi.nlm.nih.gov/pubmed/21591859

So it can be done. My next task is to find someone willing to attempt it, or devise a way to cauterize that's not permanent and can be reversible in the future.

I didn't waste my $500 flight ticket for the cancelled surgery. Rather I booked in to have Meibography and LipiView done (we don't have those machines in our capital city of Melbourne - it's insane). The meibography revealed no gland drop out on the right eye, and partial drop out on the left eye (the left eye is always the worse, and the eye with the enlarged punctum's from DCR). The Lipiview showed my lipid layer is not too bad, but 10 times out of 10 I do not fully blink (thus partial blinking is not pumping the meibomian glands to release oil).

My views on Meibomian Gland Probing has changed. The doctor whom cancelled me as a patient 'used' to do Probing, but since his patients didn't receive the results, he stopped it. However, that's not a reason to stop and PROBING IS NOT THE REASON FOR A LACK OF RESULTS. In my case, the blocked ducts needed to be probed, and although the meibum is now free to flow, the lack of a full blink is preventing the meibum from being secreted. I was issued with blinking exercises, purchased a BlephaSteam and will gently express my glands.

Since the optometrist could easily express my glands with his fingers with copious meibum secreted, and as evidenced by LipiView, he suggested against LipiFlow. He also said the main priority is to occlude the Left eyes punctum's.

DCRYdryeye, I tend to agree with you on the LASIK comment. There is a lot of money to be made and the doctor has a choice on how he spends each working hour: make money with LASIK or helping someone like you for less.

My uppers were cauterized in away that is reversible. They are now partially opened and I have had no problem with them. If you like, I can find out the name of the procedure, because like you suggest, there are different kinds of cautery. You won't have the same doctor do it (I'm in Florida, you're in Australia) but at least knowing this might help your investigation into the right procedure for you. I can't make any promises, but I can at least ask about it. Would you like me to?

Good to know your position on probing. Did they tell you why you aren't blinking fully i.e. is there a co-morbid disease? For example, if you have ATD, then this can cause decreased cornea sensation which in turn can lead to decreased blinking. Or you might have lashes that collide so you don't close your eyes completely when you blink. Or did they say something else? What are the exercises?

Also, great that you are secreting copious amounts of meibum. That IS good.

[DCRdryeye]

Hi NotADry eye, yes that would be fantastic if you could obtain the name of the procedure to 'temporarily cauterize' so it's reversible. I have an ophthalmologist willing to try anything and devise new techniques.

I wasn't told why I'm not fully blinking. I do have thick eyelashes and noticed they were clashing on the LipiView, not much can be done about that unless I cut them off

The blinking exercises are very basic, slowly shutting the eyes and being aware of it, slightly squeezing the eyes and opening again slightly wider. It's to re-train the brain to use the same neuronal networks since 'Computer Vision Syndrome' is the likely cause. My dry eye symptoms developed after graduating. I'd spend many hours at the computer for years, often up to 4am which trained the brain to blink less, thus it occurred all the time...and eventually ATD. I do keep the eyes moist with hypo-oncotic drops (Sodium hyaluronate, Optive and Thera tears).

[NotADryEye]

DCRdryeye, I asked. My doctor doesn't have a name for the way he does the reversible cautery procedure. It's just a way or technique that he's developed over time with his patients. I know it works from personal experience with no issues what so ever.

My lashes collide too. My doctor has pulled them out and sometimes I do if I need to. It's not painful, just a little pull like plucking eye brows, though I don't suppose you do that. You just have to be very careful, focused and have a steady hand if you do it yourself. If you are able to get the right lashes, you can feel your eyes closing more and better. Your eyes might even feel like they open more after you pluck the colliding lashes because they can get entangled when you open your eyes. The only issue for me with plucking is that when the lashes grow back it is very uncomfortable, particularly if you pluck a lot and if they are in a bad spot, like at the lid margin.

[NotADryEye]

DCRdryeye, good news. My doctor is happy to discuss the reversible cautery procedure with your doctor. E-mail is probably best since you're in Australia and in we're in the US. I'll send you his e-mail address via pm. Keep us posted.

[DCRdryeye]

Sorry NotAdryEye my mail box here was full...will delete a few of them.

[NotADryEye]

Great. I've resent the contact info.

[NotADryEye]

DCRdryeye,
Do you know if your doctor had a chance to contact my doctor about the reversible cautery procedure? Wondering how that went...

[DCRdryeye]

Hi NotADryEye,
I've recently been in touch with my doctor (whom is interstate) and he doesn't like the idea of 'cauterizing' at all, and obviously he believes the outcome of 'partial cautery' cannot be totally guaranteed. Rather, he spoke to an eyelid surgeon friend whom suggested a possible solution that is totally reversible. It's an advanced suture technique to totally close the puncum's and they can be reversed at anytime. So it will be like having a cautery without the trauma to the tissues and with the option of reversibility.

My ophthalmologists friend whom recommended the technique is an oculoplastic surgeon specializing on eyelid problems, lacrimal gland disease, etc. Apparentely the suture technique is not very difficult and I will consult a local oculoplastic surgeon in my capital city. If she won't perform the procedure I'll have to make two plane trips interstate...again!! $$$$. It's been the travelling that's costing more than the treatment recently.

[patientpatrick]

The suturing technique seems very fascinating. My eye doc is against cautery as well, but I keep loosing plugs and they still feel like i have a grain of sand in my eye. Please keep us posted on the surgery.

P

[DCRdryeye]

Yes cautery and plugs just isn't the solution for some people. Plugs come out, cause scarring, rub against the eyeball, etc. Indeed, this advanced suturing technique is a real possible solution where permanent sutures are used and buried under the skin so they cannot be seen or felt on the eyeball. 100% punctum closure is achieved, and is reversible at anytime.

I'll certainly update and let you all know how it went. However, being the start of a new year, the local oculoplastic surgeon doesn't commence work till 14 January, and if I discover her waiting list is 3 months, I'll have to fly interstate since the doctor whom brainstormed the idea is already back to work, and available for consultations within days...not months. A gut feeling is telling me to fly and see the top surgeon whom suggested the technique. Always go with the gut.

[NotADryEye]

Hi NotADryEye,
I've recently been in touch with my doctor (whom is interstate) and he doesn't like the idea of 'cauterizing' at all, and obviously he believes the outcome of 'partial cautery' cannot be totally guaranteed. Rather, he spoke to an eyelid surgeon friend whom suggested a possible solution that is totally reversible. It's an advanced suture technique to totally close the puncum's and they can be reversed at anytime. So it will be like having a cautery without the trauma to the tissues and with the option of reversibility.

My ophthalmologists friend whom recommended the technique is an oculoplastic surgeon specializing on eyelid problems, lacrimal gland disease, etc. Apparentely the suture technique is not very difficult and I will consult a local oculoplastic surgeon in my capital city. If she won't perform the procedure I'll have to make two plane trips interstate...again!! $$$$. It's been the travelling that's costing more than the treatment recently.

It's really too bad that your doctor hasn't spoken with mine because I assure you that my reversible cautery procedure was simple, effective and reversible. But it seems that your doctor already has his mind made up about this. I suspect only another professional might be able to change his mind. And unfortunately for you it means you may be facing wait times and/or expensive travel.

Is your ophthalmologist also a surgeon or non-invasive?

Best of luck, keep us posted.

[grant555]

i think the lesson of this thread is that different treatments work for some people, some do not. i hate that the person who started this thread stated "Do not get probing." You can provide your personal experiences without having to tell other people what they should or should not do. Everyone has different reasons for their problems. Probing may be helpful; it may not. This forum can't even agree on what eye drops are the best because they affect each person differently. Also, for what its worth, ****** does admit that the probe could cause scarring, if done incorrectly. I personally would not trust most of the doctors who do probing in the United States unless I am assured that they trained extensively in it.

Also, DCR, I also have lagophthalmos (noctural and partial blink) which I have had for about 12 years. I have also found that unless you address your blinking mechanism, no amount of probing, IPL, expression, or anything will result in sustained improvement. I have recently made some improvement with closing my eyes at night, and as a result, my symptoms have improved to some degree. I am likely going to have eyelid surgery to correct the issue as I am about out of other options.

If you are a partial blinker, you'll likely want to check to see if you sleep with your eyes open as well. I was recently diagnosed with sleep apnea, which it turns out is associated with eyelid issues, i.e. floppy eyelid syndrome, which is very similar to lagophthalmos (both involve weak eyelids). This is why you'll read on the message board about a lot of patients who have seen Dr. Tseng in Miami. He often tells patients to get tested for apnea and there are a couple success stories on here of people whose symptoms improve after treating the apnea.

Have you tried nighttime eye protection? I hear it works wonders for a lot of people. I unfortunately can't sleep on my back due to the apnea so haven't been successful with something like Tranquileyes. But, if you don't have nocturnal lagophthalmos, then it may not be as helpful.

I personally think eyelid exercises are useless. i have never heard of anyone curing their lagophthalmos from blinking exercises (admittedly there is not much research). I know Lipiflow pushes these to people. I think it's great that doctors generally don't perform lipiflow on people who are partial blinkers, because they are recognizing that the treatment won't work because it does not address the underlying problem. But I don't think blinking exercises are effective. But give them a shot, and let us know.

I also personally think partial blinking and nocturnal lagophthalmos are a much bigger issue in the dry eye world than currently recognized. Computers seems like the likely culprit. I would like to see more research connecting poor blinking to MGD and blepharitis because as you said, if the eyelid isn't "expressing" the oil each time you blink, then that oil will sit there and eventually increase bacteria and cause the glands to become inflammed and malfunction. (I also think that eye drops have been unsuccessful for me for the same reason - the blink does not spread the drop over my eye making the drop useless)

Just some food for though on your lagophthalmos diagnosis.

[Meda]

Though I did quite a bit of research prior to going to Tampa for probing, I sure wish I had read these posts. It has turned out to be one of the worst decisions I made. As it appears is the case with almost all people who see this doctor, the cauterization of all four puncta was recommended to me. I would not have considered it for a second if I hadn't been told it was a light, partial and reversible procedure. This has NOT turned out to be the case! i am in the process of meeting with Oculoplastic surgeons across the country to choose the best one to try and correct the epiphora and burning I have and my condition is so much worse than it was before my fateful visit to Tampa. I have since learned from an extremely reputable Opthalmologist that he never recommends that people with OR have puncta closed due to poor quality of tears and inflammation issues. I believe the probing also exacerbated my Ocular Rosacea issues as my lids are much more inflamed than before and it has been three months since I had the procedure. I fear the people who have posted about probing causing damage to the glands may be right. I totally agree that the reason this doctor recommends punctual occlusion so frequently is to make it more difficult to dispute success of probing. And then of course his final solution seems to be to come back for the extremely expensive amniotic membrane surgery. No other doctor before or since believes I need this. I'll end this by saying to beware of people on this forum who are pretending to be patients singing the praises of probing and trying to shut down any negative comments made about it.