I saw yet another cornea specialist today who came highly recommended. He told me he saw the beginning of cataracts in both eyes but I shouldn't worry ...not yet. He also thought that my tear ducts could be blocked and that's why i have the excessive tearing. That is exactly what you thought Dr. Harzok and you didn't even examine me ! However, he is sending me to an occularsurgeon who's expertise is in eyelids. I asked about irrigation and he felt that it would determine if ducts were open or closed but I probably would need lid surgery bec. irrigation would not necessarily open the ducts. IS there any other way The tear ducts could be opened??I dont really want lid surgery. He also put me on ALrex which he said is milder than lotemax. TOld me to continue the artificial tears. HE said I had a layer of tears lying in the bottom lid which he suspects could also not be the "healthy" kind. SO I could have 2 things going on here.
What is your opinion Dr. Hartzok regarding the blocked tear ducts..How the heck did they get blocked and how can i avoid surgery??

Ocular plastic surgeons irrigate tear ducts all the time. If irrigation is not effective, he/she may use a nasolacrimal probe to open the duct. Surgery would only be necessary if probing was unsuccessful. I would not be overly concerned with the idea of surgery. I have had numerous patients go through lacrimal duct surgery and it has not been difficult for them.

How did the lacrimal ducts become blocked? I wonder if perhaps one of your previous doctors instilled intracanalicular plugs (the type that are placed within the duct, as opposed to plugs that remain in the punctum). If so, then it is possible these plugs worked their way down the lacrimal duct and are still present. In other cases, patients simply have blockages that occur naturally.

It is good to go to an ocularplastics specialist for this; someone experienced.

I had lower plugs inserted back in 2000. They were removed this past Dec.2005. Actually one was half out but the cornea specialist that took them out said sometimes the tissue around the duct gets inflammed or grows around the plug.. SO when he took them out the surrounding tissue blocked the duct??

It's plausible that inflammation closed the duct. Removing the plug should have allowed more tears to drain; since that didn't happen, there may be a stenosis (narrowing) of the duct or even closure. The ocularplastics specialist should be able to differentiate the degree of closure.

I have another question if you don't mind.I got my new prescription and the reading part of the progressive lens was -1...When I got the glasses I couldnot read clearly so the doctor changed the prescription to a "2".
I picked up the glasses yesterday and the reading part is STILL not clear..does it take time for eyes to adjust..is something else going on here?? or will the artificial tears make eyes somewhat blurry and affect reading??
I keep blinking in hopes that the vision gets clearer.

Spectacle prescriptions are written for the right eye (OD), left eye (OS) and, for a bifocal, trifocal or progressive, specify an ADD - the power that must be added to the OD and OS prescription to adjust the focus for reading. It is usually written between 0.75 and 2.50, with adds higher than 3.00 usually reserved for patients with reduced vision. A "1" would certainly be weak for you. A "2" would be more accurate.

If your distance vision is reasonably clear but you are struggling to read with a progressive, written as 2.00, two things could be happening. (1) The distance Rx could be inaccurate which would make the reading portion inaccurate. One way to tell is to look at something across the room. If you see better with your chin held a little high and, therefore, worse when your chin is lowered, then the distance Rx is off and you are not getting a strong enough reading power. (2) If the distance vision is good and does NOT blur as soon as you raise your chin a little, then perhaps the lens is too low in your frame and you are missing the reading zone when you read. In other words, the set up for the progressive lens is wrong.

In either case, if your reading is unsatisfactory relative to your distance vision, you need to have the prescription and the lens mounting checked. It takes awhile to get used to new glasses but what you are experiencing does not sound like an adaptation problem.

THANK YOU SO MUCH Dr Harzok for taking the time to write. I really appreciate it.

WHen I wear my glasses and lower my chin there is no blur for distance but when I raise my chin there is a blur for distance.
SO the lens may not be mounted correctly then?

With a progressive, when you raise your chin slightly, the distance should begin to blur. If it doesn't, then the lens may be set too low in the frame. Since your distance vision blurs as soon as you raise your chin, it does NOT sound like the lenses are mounted too low.

This is a rough way of determining the set up. The only real way is to have the set up re-checked by your dispenser. If the set up is good, then you need to return to your doctor to check the Rx.

One other thing you can try. Based on your history of excess teariness, if the volume of tears along your lower lid is profuse, as you look down to read, you will be forced to look though the excess tears and THAT will blur your vision. One thing you can try is to hold some reading material in the normal way. Without changing the position of the glasses on your face or your head posture, pull your lower lid down on both sides (this can be done with one hand by first placing fingers on your cheekbones). If pulling down your lids clears your vision, then it is the excess tears blurring your vision and not the set up or the prescription.

I have a feeling that it is the excessive tears that are causing the blurriness.

I've been noticing that after I do the hot
compresses my eyes feel "normal" and the tearing subsides..for about20 minutes, then the tearing starts up again..
Do you know why the tearing subsides with the hot compresses?

Hot compresses may be increase the flow of the meibomian glands, putting more oil into your tears, preventing the evaporation of tears and temporarily relieving dryness. However, I wouldn't think of this as an immediate effect lasting for twenty minutes. The relief would be more subtle, providing a benefit over the course of the day and measured in weeks.

The only other idea is that the lid margins are temporarily hydrated, providing short term comfort.

I need your opinion on this Dr. Harzok:

When I originally went to the cornea specialist complaining of excessive tears I still had both lower plugs in my eyes. He took them out and now says that the lower tear ducts could be blocked...I am still tearing. I am so confused..If the eyes were tearing with the plugs in...and now with the plugs out...could it just be a bad case of dry eyes causing the tearing or should I still have the lids examined to see if ducts are blocked..
I'm so disgusted.. Eyes feel like crap.

It's plausible that inflammation closed the duct. Removing the plug should have allowed more tears to drain; since that didn't happen, there may be a stenosis (narrowing) of the duct or even closure. The ocularplastics specialist should be able to differentiate the degree of closure.

Now my eyelids are springing up !! What the heck is going on??
Tomorrow is my appt. with an ocular surgeon...praying that he can help me .

saveyoureyes,

I hope this doesn't sound impertinent, but what exactly are your lids doing? Does it feel as though the muscles are pulling them up? Is there any sort of strain to closing the lids? Is this bilateral? (My left eyelid doesn't close at the same time or at the same rate as the right—damaged in surgery.) Did you notice anything different before this started to happen?

Good luck tomorrow at the ocular surgeon. I hope he's able to give you some relief.

It feels as if the muscles are pulling them up and it is bilateral. NOw today it hasn't happened..I'm thinking it has to do with the dryness?? Who knows?
I don't feel any strain when I close them and after I put in some artificial tears..they go back to normal. ANd sometimes I think the different brands of artificial tears causes it too. Really puzzling!!