Sjogrens and the benefits of tear duct cauterization

ImageMy left eye immediately after punctal cauterization

Punctal plugs Vs Cauterization of the tear ducts

I have had punctal plugs in both eyes (lower) for quite some time now and although up until recently they have been tolerable, because I literally have zero tear production, I have been able to feel them when I do the slightest eye movement and not only did it feel as though I had grit in my eye thus giving me an urge to rub my eyes to relieve them, it was also a constant and blunt reminded of my Sjogrens.

I had seen my eye specialist and had asked him if I could have them permanently cauterized shut and he agreed but said that I could only have one done at a time just to see how if it would be successful.  My left eye was done last week and my right eye is due to be done in 8 weeks.

The procedure itself

I had some local anesthetic eye drops put in my left eye, the plug removed and then I had to lie on a bed where I was given a small injection around the tear duct, sorry I cannot be more specific on this but as you can imagine, I couldn’t see exactly what was being done   and where.

It was only a tiny fine needle but when you see it coming towards your eye, it is quite nerve-wracking – well it was for me anyway.  The injection did sting slightly and was a tiny bit uncomfortable but it took effect quickly and within seconds I could feel nothing at all.

The procedure itself was completely painless, honestly I could not feel a thing at all and it was all over and done with so quickly, before I knew it I was in reception making an appointment for my right eye (and paying the cash for my left!)

Afterwards

It was a few hours later that my eye began to sting and felt bruised, not really bad I must emphasize but uncomfortable and for a few days afterwards I had severe itching.  My specialist advised me to get some new reading glasses so I mentioned the itching to my optician and he assured me it was part of the healing process, my eye drops helped with this.

Has this made a difference – plugs Vs cauterization?

What has been noticeable for me is that I do not have that gritty annoying feeling in my left eye, it almost feels normal.  Normal in the sense that it is still dry and still requires drops every 5 minutes or so if I can remember, but I don’t have the constant Sjogrens reminder which to a healthy person may seem daft but to a person with Sjogrens, having that constant awareness of your punctal plugs and being able to feel them, is a constant reminder of your auto immune disease.  You may get what I am saying or you may not, I am just explaining how I feel.

For me it has been a good investment and I am looking forward to getting my right eye done in June and now I know what to expect, I will find it easier.  The worst bit is the injection and even then, I have experienced far worse in the form of blood tests etc.  The best bit – finally losing the gritty feeling in the right eye and being able to rub my eyes without worrying about dislodging the plugs.

In my personal opinion it is well worth doing.

Samantha Rose (C) Copyright 2013

25 thoughts on “Sjogrens and the benefits of tear duct cauterization

  1. Thanks, Samantha Rose , for your detailed description of the cauterization procedure. I, too, have Sjogrens, and suffer terribly from dry eyes. Permanent punctal plugs didn’t help as it appears that they were dislodged. I’m having my right eye done (cauterization of tear duct) this coming Thursday, didn’t know what to expect or how I would feel afterwards, so it was wonderful to read about your experience. I hope I will also be pleased with the outcome.

    Regards,

    Nora

    • No worries Nora.

      I am due to have my second one done on June 19th. I cannot wait to be honest. As I could always feel the plug in my eyes as they are that dry, it was like having grit in them each time I rolled my eyes and that to me is a constant reminder of Sjogrens.

      Having it done was the best thing ever, my eyes are still dry obviously but they are more comfortable than they were and it is nice to be able to rub my eye without fear of the plug coming out.

  2. I had my tear ducts on the bottom permanently cauterized shut 10+ years ago due to Sjogrens dryness. It was the best thing I ever did! Practically overnight I went from using eye drops all day and gel at night to not using them at all. It was truly a miracle cure. For some reason now my one eye is dry again so I may go have the top ones done soon. The needle to numb the eye is rather painful and left me with some black eye marks, but the relief was well worth it!!!

  3. I have been using eye drops for about 15 years. I tried plugs several times, but they would just come out after a few weeks. I also was using lenses to protect the cornea. The Dr. finally recommended cauterization. I went for it and had them cauterized about three weeks ago. They did the top and bottom of both eyes at the same time. The anesthetic needles were fairly painful, and I looked like a raccoon for a few days, but the worst for me was the itching during the healing process. HOWEVER, the end result has been awesome. I no longer need the cornea patches and I went from using 1 30ml bottle of tears naturale and 3 packets of Bion tears per week to only 2-3 vials of bion tears per day. I think once they heal completely, and I am off the anti-biotic drops, I will be down to one vial of drops per day.

    • Hi Jeff

      I have the upper lids cauterised and it has been the best decision I have ever made, they considered doing the lower lids but after trying temporary plugs, my eyes were too watery.

      How nice it is to be able to rub my eyes without fear of dislodging the plugs, although I can only rub them once I have put drops in as I dont want to scratch the eyes which can happen if you rub them when they are dry.

  4. Thanks for this information. But…. Even though you have a good feeling about not having the plugs anymore. I don’t hear a lot about the condition of your eyes. Are they less dry???
    I have no tear production either.. Would my eyes be less dry and painfull after that treatment? I have ‘scrlera lenses’ which help a lot. Next to that i don’t really want to use fake tears every damn 5 minutes.

    • To be honest with you, I am still using my drops just as much – my specialist said my eyes are ‘dry for good’ as to quote him. What I am finding better is the face when my eyes were so dry, I could constantly feel the plugs in my eye and it got really uncomfortable and started to bother me.

      Since having them cauterised, yes – I do still have to use the drops and in the Perth summers, it seems to be constant but it is nice not having the plugs irritate my eyes.

      My eye specialist has asked to see me in two years time, or I can go sooner if I have any issues so I am assuming the condition of my eyes remains the same.

      But one thing I do know, and that is my eyes are not as sore as when I had the plugs – so for me, that is a big bonus.

  5. Hi, I have severe dry eyes from GVHD and I had lower punct plugs put in at Freo Hospital but they have just come out last night after exactly 5 weeks, I think I must have inadvertently rubbed my eyes last night when I did it have drops on me. Would you please tell me where you had the cautery done, who is the doctor a show long did you have to wait? I cannot stand my dry eyes and it seems like they are worse now, like the plugs may have stretched the ducts. My Schirmer test prior to plugs was 2.5 and 3. Thanks for any advice?

    • Sorry for the autocorrect errors, I meant I rubbed them when I didn’t have any drops on me. I also meant how long did you have to wait to see the doctor and then to get the procedure done ? I had to wait 3 weeks to get a first appt at Freo then another 6 weeks to get the plugs as the specialist only goes there once a month.

      • I am so sorry for the late reply in this message, I have only just seen it. I had to wait 4 months just to see a private specialist at Murdoch but once I saw him I only had to wait a couple of weeks. We had to go private as i think the wait list was so long and this doctor is very expensive, we cant afford it. Now he only sees me every two years to dilate my pupils as I am on plaquenil. I thought it should be every year but perhaps things have changed.

  6. I had upper corners of my eyes puncta cauterized. The office procedure was painless. The two weeks since- has been constant dripping wet eyes. I was not be able to work or barely drive the car. I am on my 3rd week and have apt. with Dr. I have used Prednisone eye drops (Dr prescribed) warm compress, artificial tears. to no avail. I am so far worse off than with dry eyes. I was not told of any side effects to cauterization. The plugs itched badly so that was not for me. My eyes are a mess and this is 2weeks now. So, dont get how people recover with no problem.

    • That must be awful for you. After I had my top ducts cauterized, they tried me with temporary plugs to the bottom ones and I had pretty much the same symptoms so the plugs were removed. Thank god they were because I could not have lived with that, I also had temporary plugs before the tops ones were done.

      I really hope things resolve for you, mine are still OK – well, still dry and itchy but much better since the procedure. I suffer heaps in the Summer though.

  7. Hi

    Word of advice the bottom one does only sting but if you do the top ducts be prepared the pain is very bad i have had my top 2 done and one bottom. They broke my plug off into the other. It has helped though with the gritty feeling but not with the eye discharge.

  8. I just had this done and was rather stressed.
    I thought the shots hurt worse in my left eye than right, but the doctor burned his finger doing my left eye 😂😂😂
    I also have Sjrogen’s — not so fun journey since 2008

      • Yes i had all mine done twice, at separate times, and the left eye is still sealed after about 18 months and the right eye is not quite sealed but it’s ok because its not the worst one, and i guess its reduced enough to be effective. You can tell when they open a bit because the eye is immediately dry again, mine opened up after i had a bad cold and i think it may have been from the pressure of blowing my nose.

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