DCR or not

[dss1]

I posted a while back because I had been having a chronically inflamed eye.  I have been being treated for this since July.  Out of contacts for 2 1/2 to 3 months now, still with a red eye unless I am on Zylet.  I have been on Zylet for about 3 months straight now twice daily.  I developed a watery eye at the end of August and was told the puncta were occluded probably due to the chronic inflammation (which we still don't know why, started like pink eye but then just stayed red) and was referred to oculoplastic MD.  Had punctal snip and stenting performed.  After stent removed, watering was ok for only a week, then started watering again.  MD probed and irrigated the puncta, which were still open but now I have some regurgitation of fluid back into my eye, and some goes down the nose into throat.  Feels like I have a partial obstruction further down and is recommending DCR.  I am a nurse in a cath lab and the watering is driving me nuts at work, especially when scrubbed into a sterile procedure, well really just anytime is drives me nuts.  Any comments on success of DCR??   The oculoplastic also sent pathology on snipped puncta which showed chronic inflammation and scarring...oculoplastic mentioned pemphigoid???  I looked this up and seems unlikely to me..  I have an appointment w/my regular ophthamologist in a couple of weeks to discuss this, since oculoplastic scared me with that possible dx.  I had a dx of herpes in this eye about 6 years ago.  That is not the case this time, but my problems are in the same eye.  Any ideas about the chronic inflammation?  Could it now be the inflammation caused the punctal occlusion etc. and now the chronic tearing is causing the inflammation to stay around??  Another concern is doing the surgery but the inflammation not going away and causing more scarring...UGH...The eye is otherwise healthy, vision is fine when tears are cleared, pressure is okay, cornea is ok.  Is my eye a Zylet junky?  Nuff said.  Thanks.

[DCRbullied]

I'm a 37 yr old male and had an endoscopic DCR on my left eye in Sept 2007. I have multiple complications from it including severe dry eye. It's almost been six months since my surgery and I'm still noticing pain at surgical site. It's also annoying and freaky to feel air blowing out of my eye as I breathe and talk (because they make an opening in your nose to your eye). I have to use regular artificial tears which only provides a bit of relief yet air conditioners and wind really irritate the eye. Indeed, dry eye is worse than a watery eye. So the DCR surgery has removed one problem and replaced it with another problem that's worse and far more dangerous (dry eye can cause corneal damage).
I've also developed inflammation on the white of my DCR eye (scleritis) which is from the dryness and air regurgitation.
However, your DCR surgery may go without incident. Best of luck with it and please do keep us informed of your progress.

[jansmomof3]

I have seen 3 opthamologists in the last 4 months for advice/consultation on my constant watering eyes (both eyes).  I am having a DCR tomorrow (Jan. 25th) on my left eye.  I had thyroid cancer and radioactive iodine in January 2007 but none of the docs will agree with me that the RAI caused my tear duct blockage.  I know this is a common side effect with other thyca patients but I don't think the docs see enough of it.  My left started watering in August 2007 and my right eye started in October 2007.  None of them were able to "poke thru" in the office so now it is surgery.  Do you think or know that RAI can cause this obstruction?  Once they are blocked is there anything (accupuncture, etc.) that can help or open them or is surgery my only choice?  What is the recovery like as far as pain? bleeding? etc.?

[John C Hagan III, MD, FACS, FAAO]

Hello dss1  First let me tell you and readers what a wonderful profession nursing is. My mother and two of my aunts were RNs and I worked two summers as a nursing assistant at the Cook County Hospital. We need more nurses and they need better pay and benefits.

Now to your question.  Please discuss with your regular Eye MD about getting of Zylet. I'm very concerned you being on it that long. It has a steroid in it with all the possible side effects especially cataract formation and steroid glaucoma. PLUS steroids need to be used very carefully and vary sparingly in eyes with a history of Herpes Simplex as it can cause a reactivation and let the virus penetrate into the middle layer of the cornea where it forms a bedsore like ulcer.

I also think pemphigoid is unlikely. That's not usually a hard disease to diagnosis. Pull down the lower lid and you see scar bands running from the back surface of the eyelide to the eyeball and tethering it down.

The inflammation could just come from dry eyes (remember the discussions here about how Restasis works by reducine the omnipresent inflammation in dry eyes) or from poor drainage.

The state of the art is DCR (dacryocystorhinostomy  draining the tear sac into the nose) is endoscopic surgery through the nose. The success rate is about 70-80%.

You might discuss with your Eye MD switching from Zylet to a trial of Restasis,  or possibly a trial of one of the new non-steroidal antiinflammary eyedrops.

Good luck

JCH III MD