I spent almost 3 hours at the ocular surgeon's office today. He said without a doubt my ducts were blocked and he couldn't even see the hole in one of them. He stuck this needle-like probe into them (and it wasn't pleasant!!!)Then he irrigated them with water and I felt the water in my throat...HOWEVER...because the holes were so small..he didn't think this could be the answer and I might need a surgical procedure to open them. He wants me to call him in a few days and let him know if the tearing subsided but how will I know if the tearing is also due to the dry eyes. Dr. Hertzok -- should I wait and continue the regimen for dry eyes and start using Lotemax again to see if that helps before I call the doctor back?? ANy other suggestions..I'm really disgusted.
First I get plugs in ducts to close them in order to help dry eye and now I might have to have a surgical procedure to keep them open.

There are two ways that I know of to open and keep open a punctum. One involves enlarging the punctum by making a small cut in the side of it, essentially enlarging the opening. Another way would involve placing a fine nylon or plastic filament (a little like fishing line) through the superior punctum, running it through the lacrimal duct and back out the inferior punctum and tying the ends together. The monofilament is left in for a few months while the ducts and puncti gradually enlarge in circumference. This is not a painful procedure and although it may sound a little strange, it isn't a big deal.

Based on your most recent examination and findings, medication for dryness would not seem necessary; the excess tearing is due the lack of drainage. This does not mean the eyes are not dry. But if the primary problem is excess tearing, then you could expect your present dry eye strategy to be less relevant.

THe ocular surgeon explained about making an incision to keep the ducts open. ALso said he would have to numb eye with an injection in the corner of each eye and this is more painful than the procedure to irrigate the ducts.
I'm scared to have this done.

The injection should not be all that painful.

Was this an ocular plastic surgeon or general (anterior segment) ophthalmologist? Did he say anything about the other procedure (placing the monofilament line)? The latter does not require cutting or incision.

He is an ocular plastic surgeon from the University of Ophthomology in Newark, NJ and he did say the injection in the corner of the eye is painful. He did not mention the other procedure.

Why don't you call his department and ask if there is another procedure. Snipping the punctum is easier but if the procedure sounds threatening to you, ask him if he has any other suggestions. The procedure I mentioned will distend the punctum and keep the lacrimal ducts open. If is usually reserved for lacrimal duct stenosis but it will also distend the punctum. However, months after the filament is removed, the punctum MAY revert back. You would have to depend on his experience in these matters. Perhaps he feels punctal snip is the best way.

Something brought me to tears today and after a few minutes of crying, I had to blow my nose.

WOuld this mean that my ducts are still OPEN have the irrigation procedure I had done last Thursday??

YES! And if the excess tearing is reduced, then you can defer a procedure for now. Probing and dilating the puncti can be therapeutic as well as diagnostic. Consider whether the tears were draining into both nostrils or just one.

I felt tears in both nostrils.

Yes- tearing has subsided somewhat but not all together. Does this mean that the tearing can still be from DRY EYES.
My eyelids are springing up and look big. Is this from my eyes being dry??
My Doctor told me to wean myself off steroids as it could be causing Rebound effect plus cataracts. I haven't used any artificial tears either and eyes feel tight. So confused as what to do next. I did order Dr. Holly's drops.

The tearing has not subsided entirely means there is still some stenosis (slow tear drainage) and/or some excess tearing due to dryness. I would use Dr. Holly's drops religiously for a few months and see what happens. This is not an exact science. You got relief by simple punctal dilation and irrigation. That can be repeated if necessary. If relief is associated with dilation/irrigation, then this is something to pursue surgically.

WHich of the drops would you recommend??

Thanks!

Dr Holly's drops:
Dwelle—thickest, good for at night before bed, during the night
Dakrina—not quite as thick, good for in the morning when you need good lubrication and comfort
NutraTear—lightest of the three, pink in color, good all-around, all day drop

Do a search here on the BB for keywords "Dwelle diary", "Dwelle", "Dakrina" or "RedKote" or "NutraTear", and you'll find lots of info about all of them and what users have to say about them.

THANK YOU!!

I have been using nutratear drops and my eyes feel wetter..but that is not a good thing for me bec. the tearing has increased

SHould I give it more time or switch to another one of Dr. Holly's drops?

The tearing subsided following punctal dilation and irrigation, suggesting stenosis of the lacrimal duct as the underlying condition. If the tearing is now returning, go back to the oculoplastic surgeon and ask him about dacryocystorhinostomy.

well- i know that the tear ducts are still open or at least partially open..so I am hoping that the tearing is due to dry eyes and am just testing different drops to see which ones will suit my needs.

Saw the cornea specialist again today and he said that there is punctal stenosis on both lower lids and that I will need the minor surgery.
So I'm off to the ocular surgeon again.
QUESTION-- for Dr. Hertzok
I am going on a cruise in a few weeks. SHould i have the procedure before I go (if the surgeon is available) or wait until I get back. I'm worried in case there is a complication of some sort..with my eyes you never know ! Yet - I can't stand this constant tearing. The cornea specialist said i had a thick layer of tears on both eyes.

It really depends on what procedure he is talking about. I wouldn't want to have a procedure and leave the next morning but which ever procedure he recommends, the recovery should not be long or challenging. Certainly after three or four days the potential for complications will be minimal.

Well I am having the procedure done next Wed afternoon. I will need a local anesthetic in the corner of my eyes and the procedure should only take about 5-10 minutes. I think it's called punctal snip??
I am glad i am having it done before my vacation.

HI again,
I emailed the surgeon and he said the procedure should take 20-30 minutes for preparation and then 10 minutes for each eye.
I am quite nervous as I don't know what to expect..I forgot to ask if I can go to work the next day..any idea Dr. Hertzok??