WHAT NEXT????

[Cindykoop]

I'll try to make this as brief as possible.  I got punctal plugs 6 years ago after a diagnosis of dry eye. Within a year, my eyes started to water ALOT. I did not want to return to the eye doctor who put them in becasue she was rude and always gave me a hard sell on skin care products, etc. when I went to her office. I consulted another doctor who tried to irrigate the plugs out.  He was unable to do so and referred me to another doctor.  The new doctor also tried to irrigate and even push the plugs down through, again without success.  In the meantime, I developed ptosis in the right eye and he operated on that and simultaneously performed a bleph on my left eye.  My eyes loked somewhat better, although the right eye had a visual "peak" on the inside side of the iris and obviously dropped downhill from there.  He acknowledged the peak but said it was not too bad and kind of blew me off.  My eyes continued to water in addition to the what I felt was a malpositioned eyelid (he did not cut with the crease but actually in front of it, so it forms like a fold when I open my eyes.)  He said the only thing he could do was surgically create tear ducts to relieve the tearing. The left eye seemed to be okay but the right eye continually welled up and dripped.  After the ptosis surgery and bleph, my vision geadually got worse and another doctor eventually found that I had cataracts in both eyes (at 47 years old) and they were repaired with success.  He, too, acknowled the "peak' in my eyelid.  Recently, I consulted with a "top doctor" in Philadelphia who put dye in my eyes and tried to irrigate both top and bottom ducts in my eyes.  All four are blocked.  No one is sure whether the plugs are still there and my skin has adhered around them or if the plugs are gone and scar tissue remains totally blocking the ducts.  He wants to cut into my face about 1 inch long incision on either side of my nose, drill through some bone and insert tubes.  My question is...is there no other relief other than this very invasive surgery?  He said no, but I still feel like the lid is part of this problem.  It almost feels like scar tissue on the reverse side of the lid is rubbing at a weird angle and creating tearing.  I also have found tiny lashes which grow down into and poke my eyes causing them to water.  Am I crazy to suggest to him that he try something with my lid first before cutting my face open?   Would I be insulting this "top doc" by asking him to address the lid first when he said it was no big deal?  I am totally frustrated and at the end of my rope...I just want another opinion.  Can anyone help me...please?  I am only 49 years old and I feel like not all options have been explored yet!!!  Thank you.

[John C Hagan III, MD, FACS]

I think it highly unlikely that the procedures done on your upper lids and the less than perfect appearance contribute to your draininage problem. I think more surgery on the lids would likely be counter productive. Ptosis surgery rarely makes the eye "perfect" and back to normal in function or appearance. It usually makes it "a lot better".

I have long discouraged people from having indwelling plugs put in the eye example SmartPlugs. I believe all plugs should be the type that have an external cap that can be used to easily remove the plugs.

I would suggest that you see another oculo-plastic ophthalmologist for another opinion. I suspect you will be told the same thing. Your scarred tear drainage system is very difficult to fix.  I suspect you will be told the same thing and they need to decide wither to live with it as is or have the invasive surgery. Also have the consultant check for eyelashes rubbin on the eye (trichiasis) and flip the lid and look under it. consider having someone at the Wills Eye Hospital doing the second opinion

Good luck. This is a difficult situation.

JCH III MD

JCH III MD

[Cindykoop]

Thank you so much for your comments and advice.  I acknolwedge I have the drainage problem and would most likely opt for relief versus living with it.  It had been annoying  enough that I have kept seeing doctors!  I have had sales clerks ask me if I am ok because they see tears and wetness around my eye(s)...So you, too believe that the eyelid itself is not causing the watering?  OK, I was just looking for an easier "fix".  I just suspected it since both eyes are blocked and the left eye without the surgical "defect" does not water anywhere near as much.  It seems something is causing the excessive watering in the right eye.
I never really had a choice about the plugs.  This I doctor I saw who inserted them just did this and never asked me if I wanted them.  She told me this is what I need.  I trusted her.  But it is also because of the way she is that I did not return to her.
I guess the surgery suggested to me is DCR?  I read that a non-invasive method is available where the doctor uses a tube and advances it throught the tear duct using an inflatable balloon and then places the plastic tubing in, all without incisions.  I wonder why this method was not suggested or offered to me.  Are there varying degrees of total blockage which require diffferent procedures?  
Are you familiar with the non-invasive balloon method?  I will take your advice and try Wills Eye.