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Hi Michelle! I don't mind at all that you are asking me questions. :) Feel free. :bouncing:


You asked about the Refresh Endura Tears. Yes, they are available in stores right now. They are made by Allergan. They are supposed to replace your own natural tears. My doc has me using them 6 times a day, with other tears as well. No studies have shown if they work better if you use them more than 4 times a day, or if you use them with other tear drops, but I have to do it because I cannot live on just using tears 4 times a day. Not possible. They are much thicker than regular tear drops, and they almost look like milk. Supposedly it takes about 2 or 3 weeks for them to really work.I personally cannot tell if they are making much of a difference because my eyes are so irritated and inflamed from allergies anyway. But my eye dr says that my eyes don't really look dry anymore. I don't know if it is from that or because all 4 of my tear ducts are cuaterized. Which leads me to your next question. :)

Cuaterization worked better for me for a lot of reasons. #1 is that the plugs CONSTANTLY fell out. I had them replaced 4 or 5 times in just a few months. #2 is that shortly after I had the "U" word (don't like to say they word U-L-C-E-R), I had the same pain again (at that point I absolutely panicked and started to cry), my doc found that I had a not so severe corneal abbrasion, because the plug could possibly have moved and irritated my eye. This only happens to one in a million people. So, all of the remaining plugs were immediately removed. #3, even if the tear duct is plugged, there is still a teeny tiny bit of room around the plug, for the tears to seep through. With cuaterization that does not happen.

Your tear ducts can re-open after they have been cuaterized (happened to me twice in about 8 months) and there is no problem with repeating the procedure.
Another thing that you mentioned is that you don't like it when the tears drip down your face. I get that too. I'll tell you two things. First of all, when that starts to happen, put some tears in your eyes. Sound silly? Well the reason that you have so many tears running down your face is that your tear glands are over-compensating. Your tears are probably a poor quality like mine, so because you don't have enough of the "good" tears, your tear glands produce more of the other type of tears (like you get when you cry or sneeze). If you put some tear drops in when that happens, your tear glands may realize that there is now a sufficient amount of the proper tears in your eyes (for the moment) and they might stop over-compensating. #2 Eventually your tear glands will get used to the fact that your ducts are closed and they no longer need to produce an over-abundance of the wrong kind of tears. They will adapt, and you will probably not always have tears running down your face. Wind causes dry eyes, and therefore can cause your tear glands to try to produce more of the wrong kind of tears, to make up for the dryness. That's probably why that happens when you go out into the wind. The same can happen if you are around A/C or heat.

About the steroid drops. I only use them because I have SEVERE inflammation (which also causes dry eyes) and itching from my allergies. Right now I am using the two strongest ones available, FML and dexamethasone, both preservative free (wouldn't you know, I am allergic to the preservatives) and they are barely making a dent. But I have to use them because I would be much worse without them. I have tried going off of them completely, and it is not fun.

Steroid drops can have some bad side effects. You can become dependent on them and get what is called a "rebound effect" when you try to go off of them. (if you go off of them, your symptoms can get worse again because you are going through a withdrawl). They can also cause Glaucoma and cataracts. My doctor says he is not worried about it for me because I am so young (22) but he still checks my eye pressure frequently because they can make it go up, which can eventually cause cataracts and glaucoma. My pressures are a tiny bit high right now, so he is monitoring me very carefully. You probably know that steroids are used as anti-inflammatory agents. For me, we are trying to bring down the redness and swelling of my eyeballs. We are also trying to reduce some of the inflammation for the simple reason that if the eyes are inflamed, especially the tear glands, they are not going to produce the right amount of tears or the right quality.

Cyclosporine can do the same things as a steroid, as far as reducing the inflammation, but didn't really help me very much. It is good though because it can be used long term (I think) and doesn't have any of the vision affecting side effects that steroids have. It is generally a chemotherapy agent used to shrink tumors, so logically it would also shrink the swelling in the eye that sometimes accompanies dryness and allergies.

Have you ever had a shirmer test (sp?) to measure the quantity of tears that you are producing? (this is where the dr puts a strip in your lower eyelid for 5 minutes and then reads the measurement). I did, and mine actually came out normal. I have more than enough tears now that my tear ducts are permanently closed, but they are just not the right quality. Isn't it amazing to have dry eyes, yet still have tears running down your face? If that really irritates you, put a thin layer of vaseline on your cheeks.

Cold compresses are also fabulous for bringing down inflammation and helping with pain and itching. I live on them.

Is there anything you should ask your doctor? What about trying an allery drop such as patanol, just to see if it helps? It probably can't hurt. Or what about a mild steroid? (they go in order: Alrex, Lotemax, Pred-Forte, FML, Dexamethasone) You might try some Alrex. (but I am not a doc, so don'tjust take my word for it!) Or what about asking about cuaterization for your lower ducts? It is permanent in that it usually does not open up on its own (although it can happen, as in my case), but it is not so permanent that it can't be reversed.

Have you ever thought about using moisture chamber goggles to sleep with at night? I believe you can even get moisture chamber glasses for during the day. Also, you might want to sleep with a warm air humidifier, especially if you have to put the heat or A/C on, which can both be very drying.

What tear drops do you use? (I too once made the mistake of using visine). I love Bion Tears. Thera Tears are good as well, and so are Tears Naturale Free. Make sure whatever tear drops you use are preservative free, because even if you are not allergic to the preservative, it can irritate your eye and you don't need it. All prescription eyedrops have preservatives, unless specially made, so that cannot be avoided. Also, there is a wonderful product called "Tears Again Gel Drops", made by Ocusoft. On the East Coast it is only sold at Eckerd Pharmacies right now. It is thicker than a regular drop, but not as thick as an ointment. It won't blur your vision for more than a second or two. It stays in the eye much longer than other tear drops, and it is very soothing. It too is preservative free. I also use Tears Naturale PM Lubricant Eye Gel sometimes during the day if my eyes are really bad and I don't need to drive anywhere. You might try using some kind of ointment at night if you haven't already.


There is a fantastic place in San Jose, California. It is called Leiter's Park Avenue Pharmacy. They can make any formulation of ANY eye medication. That is where I get all of my medicines from, because I need preservative free. They are a compounding pharmacy. That is also where you would get the cyclosporine from, because they are one of the only places in the country that makes it for ophthalmic use.

Also, how many times have you been tested for Sjogrens? Just because you test negative for it doesn't mean that you don't have it. Sometimes it takes several blood tests for it to show up. You can get false negatives.

Have I answered all of your questions?? I hope I have been helpful.

Hope to hear from you soon,
Take care,
Elyse
:wave:

[This message has been edited by purple2067 (edited 11-07-2002).]
Hi Michelle! :wave:

How are you?


Let me describe the procedure a little bit for you:

The doctor will examine your eyes (of course) and then put in some anesthetic drops. Then after those take effect, he/she will put a tiny cotton ball soaked with the same anesthetic drops into the corner of each eye. You'll sit with your eyes closed for anywhere from 5-15 minutes. (the dr will probably leave the room). Then the dr will remove the cotton and he may or may not lay the chair back into a reclining position. Then comes the worst part. You will get an injection in the first eyelid, right near the tear duct. That burns and hurts a lot. (well, not terribly, but it does hurt.) That will be given a minute or two to take effect, and by the time the dr is ready to start, you will be numb from your lower eyelid to the middle of your cheekbone. Then the dr will use a cuatery (or it's possible to also use a laser) to burn your tear duct until a scab forms and it closes completely. To do this, he will hold the cuatery directly on your tear duct for 1-2 minutes. (maybe less, maybe more depending on how fast it closes.) You shouldn't feel it (it might burn a tiny bit) if you are properly numbed. Then once that is finished, he will inject the other eye and do the same thing.

You will be given an anti-biotic ointment to use 3 or 4 times a day for 3-4 days, just to prevent infection. Once the anesthetic wears off you will be in some pain. Your eyes will burn a lot and they will be red. Your tear ducts will also be very puffy and swollen for a day or so. I suggest that you make sure that you at least have the rest of the day off from work, because you will not really want to do anything except lay with a nice cold compress. Also, you may want to bring somebody with you to drive you home, because your eyes will be very sensitive and sore, and they may be sensitive to light for a little while. It will be a little difficult to keep them open, because as the anesthetic wears off, it will begin to feel like your eyes are very heavy.

It really is not bad at all. The entire procedure, once you are completely numb, takes no more than 5 minutes, (and that includes both eyes). The worst part is getting the anesthetic injection. After that, you won't feel anything.


But you must make sure that the dr is going to use anesthetics! My doctor once told me that some doctors do not believe in spending 15 or 20 minutes numbing the patient, in order to do a 5 minute procedure. They think it is a waste of their time. Not him. He told me that he would never want any of his patients to experience unneccessary pain. He said that it usually only takes 30 seconds-1 minute per eye, but that is like 30 seconds-1 minute of putting your hand down on a hot iron, if you don't have any anesthetic.

The reason I tell you that is because like I said, some drs do not believe in using anesthetics for this procedure. Make sure you ask before you let anyone do this to you! If they tell you that they are not going to numb you, get up and walk out! Any doctor who doesn't care if his patient is in pain is not very good anyway.

I think I have answered all of your questions. :) Please feel free to ask more. I enjoy sharing my knowledge with other people.

Let me know what happens,
Sincerely,
Elyse
:D

P.S. If you are going to a new dr to have this done, I don't know if it will happen on the first visit. You usually have to make a separate appointment (unless they are having a really slow day and can fit you in.) Plus, the dr may want to get to know you a little bit (and you might want to get to know the dr and make sure you like him first!) before doing the procedure.





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