Thursday, January 20, 2011

Punctal Plugs and Cautery in Sjogren's Syndrome

Stephanie asked this really good question recently:

One of my punctal plugs fell out. Its the 4th one, and they keep getting larger. My eye doc says this time I should have my tear duct cauterized. Sounds awful. (And yet, hopefully, I won't have to be so careful with rubbing my left eye.) Do you know of anyone who has had it done?

Well, Stephanie, I haven't had much experience - either with punctal plugs or cauterization, although I have read about both a great deal. I did try one set of the plugs but just couldn't get used to the sensation and so removed them immediately. My eye doctor told me that if my eyes continued to decrease in tear production, and if I didn't tolerate plugs, that cautery was my next option.

The puncta are small openings in the eyelids that allow tears to flow out of the eye and drain into the nasal cavity via the nasolacrimal duct. Punctal plugs are tiny plugs placed into these openings by a physician to force tears to remain longer in the eye.

Image found here. 

Any Sjoggies out there with experience with punctal plugs or cauterization? Stephanie and I both would love to hear from you.

You can read more about punctal cautery and plugs here and here.


Anonymous said...

I'm a Sjoggie with a bad punctal plug experience. My opthalmologist
inserted punctal plugs in my dry eyes and I had an apparent allergic
reaction. Within a few days, the ducts around the plugs were inflamed and
very red and itchy. It became unbearable in no time, and I had to return
to have them removed. Recovery went all the way through pus, scabs, etc.
I'm back to using Restasis and Lacricerts as well as Blink on a as needed

Tricia said...

Yes I have had the cauterization done on both eyes on the bottom and have punctal plugs in the top. My doctor tried everything else and this plus restasis plus alomide plus moisture pm finally works. Occasionally I have to tape my left eye shut at night because it is so dry when I go the the opthamologist. The cauterization wasn't fun, but they do numb your eyelids and it is over quickly. Hope this helps.

Debbie said...

I have had punctal plugs in the bottom ducts for years. At times the dryness gets so bad and uncomfortable my doctor will plug the upper ducts too. It's instant relief and I may go months with all 4 ducts plugged but will eventually have to get the upper ones removed. I use Lacrisert inserts and they are great but I get blurry after several hours. I used Restasis for 15 months but did not see any improvement. Hope this helps.

Anonymous said...

Oh, my tear ducts were cauterized YEARS ago! No big deal--just sitting
right there in the ophthalmalogist's chair and he gave me a numbing
injection then used something hot (which I couldn't feel) for maybe two
seconds. It was over before I knew it, and I've never had the problems
with plugs that you mention. I say GO for it!

Julia Oleinik said...

Good input, guys Thanks.

Anonymous said...

I know that if my dryness goes worse, I'll have to try the plugs, and it's stressing me. But I'll give it a try. I didn't knew you can cautherized. I hope I don't have to do it.

Unknown said...

I have even the experience first a cauther in both eyes and later on plugs, but now a few years my eyes have been cauther again with a stich

stephanie said...

Thanks, second Anonymous, for such positive input about cauterization. I have had absolutely no problems whatsoever with plugs (except they fall out now and then) and feel much better now that you've said said it's no big deal.
(Thanks Julia, for posting the question!)

Anonymous said...

I started with plugs in both eyes about five years ago and had some success but still dry eye. Doctor suggested cauterization in both eyes and I agreed much to my dismay. I have excessive tearing (running down my cheeks) since; eyes always full of water and need to carry kleenex to blot constantly. WOULD NEVER DO AGAIN.

Valerie Polichar said...

This is late in the conversation so you may not see this, but I had plugs inserted and had great discomfort with them. After some research, I asked if I could change them out for the EagleVision Super Eagle plug, a very low-profile plug. I had the Super Eagles installed yesterday and they are already a million times more comfortable.

MimiTree said...

Valerie, now that you have had the EagleVision plugs for nearly two years, what do you think of them? Did they stay in and have they provided immense relief to the dryness??


Many thanks,

Unknown said...

Just had my lower cauterized. Not much change. Had collagen put in uppers to see what effect. Now am having excessive tearing...could the collagen be causing a reaction..eyes overflowing, itching, and redness.

Could the lower cauterization just be starting to work after a month?

Getting tired of tears on my cheeks.


Anonymous said...

Frans, plugging all 4 ducts may just be too much. What little tears we produce have to exit somewhere. The itching and redness sound like an allergic reaction to the collagen. The reaction could also be causing an increase in tearing. See what happens after the collagen dissolves. Let us know what happens.

Anonymous said...

I too have trouble retaining plugs, I have Sjogrens and have been going through terrible bouts with severe dry eyes. I finally had the duct in my left eye cauterized and I can already tell a significant improvement. A little bee sting sensation for a second and it's done. My eye is no longer gritty and irritated. I wish I'd had it done sooner.

Anonymous said...

Had cautherised left lower puncta today. I have a severe dry eye problem cos of SJS. Temporary plugs on both the puncta before cautery gave me a heavenly relief.. God..!! Hope this helps

Marcia said...

I have 3 plugs and they're a godsend. Have cautery scheduled. A bit scared but my ophthalmologist really recommended the procedure. She's a cornea specialist who did a residency at UCSF sjogren clinic. I'm hopeful

Benzgirl33 said...

I had both lower test ducts cauterized yesterday and uppers with plugs. My eyes are so sore today and my doctor did not give me any follow up instructions for after the cautetization. Has anyone else had soreness after the cautery and if so how long did it take to go away. Eyes are very sore and the lower lids are painful to the touch. I'm assuming it's just from the infection of the needed in the lower lid but oddly I can't find anything in the Internet. Lots of posts about cauterization but nothing listed showing after care if this procedure. Any info would be helpful. Thanks!!

Benzgirl33 said...

Hi Marcia, did you have the cautery done? I'm looking for any info on how people felt after the procedure. I had my lower ducts done 2 days ago and my eyes are still very sore. I was not given any info on after care so I was curious to see how others felt. I think it may just be from the needle and the soreness will dissipate but any info about your after care would be helpful. Thank you!!

Benzgirl33 said...

Hi Tricia, I'm trying to find answers to my questions on here and I'm hoping you can help me. Last Monday I had my bottom ducts cauterized and plugs placed in the top. My eyes are still very sore a week later, can you tell me if this is normal? Also I always had a lot of mucus in my eyes which the doctor said was normal with very dry eyes, says it's a way that your eyes try to protect themself since there are no tears. However since having this procedure my eyes have even more mucus and are somewhat itchy. In addition I do now have some tears that don't roll out constantly but it's somewhat annoying always having moisture in my eyelashes. I guess my general question is did you feel better immediately or did it take some time before your eyes felt normal again. The doctor gave me no information as to what to expect after having this procedure. I'm hoping that this is all normal and my eyes will start to feel better because as of now I can't stand the way I feel and am thinking of having the upper plugs removed. This dry eye stuff has made my life a living hell. Any info you can provide me with regarding your experience would be greatly appreciated!! Thank you in advance!!

Lauren said...

I have been discussing plugs with my doctor and am still undecided if I should try the plugs.
Doctor says I have NO tears so my question is how do the plugs help if there are no tears? Would it be worth doing plugs just to keep artificial tears in the eye longer?

Thank you in advance!