Jones tube problems

[julieanne444]

For years I have had right eye pain which was thought to be due to chronic extreme dry eye.  Testing has now revealed circulatory problems in the eye as well.  As a possible solution to relieve dryness, I elected to have the lower right punctum cauterized.  As expected, there was an increase of tears in the eye, and I thought the remedy would work.  With disappointment I found that even with plenty of tears in the eye, I continue to have pain.  After living with that teary situation for years, I elected to have tube placement.  

I am one week out after a successful Jones tube placement.  With the tube in place, air is drawn through the tube and then is very noticeable with the movement of air across the surface of the eye.  Now I really have dry eye, and the pain remains.  

In follow-up appointment with the doctor, I reported my current dilemma.  She indicated that one option was removal of the tube in her office, but she would like to continue monitoring the situation because of predictable post-op swelling.  At this point I want to consider the options if I decide for removal of the tube.  A hoped-for outcome after removal of the Jones tube would be a natural tear drainage opening remaining at the site of the previous tube placement.  Do you think that is a likely outcome?  My activities are curtailed at this point because of significant discomfort and lack of clarity in the vision of that eye.  Perhaps I was being overly optimistic about the success of the Jones tube.  I decided to have the Jones tube procedure without misgivings.  Now I want to consider carefully any decision made to help me gain better vision and comfort.  I have made decisions on the previous procedures with the hope they would help address the chronic pain.  Nothing has relieved the pain, and other issues have then become problematic. I have received good medical treatment, just not the improved quality of life I have been hoping for.

Please advise as to my status and prognosis.
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[JodieJ]

Based on what I've read, it is possible for the tract where the tube had been to remain open due to scar tissue formation.  This reportedly happens in only a minority of cases following long-term tube placement.

There was another man who complained on this forum about air blowing into his eye following tear duct surgery.  His problem reportedly didn't resolve over time.  (You could search the archives.)  I don't think that this is a common complaint.

I wish I had some suggestions for you.  Experiencing chronic pain is a real bummer.  Maybe another opinion from an experienced neuro-ophthalmologist would help.

[Houman Vosoghi, MD]

"A hoped-for outcome after removal of the Jones tube would be a natural tear drainage opening remaining at the site of the previous tube placement.  Do you think that is a likely outcome? "

No.  The tract will likely close shut (unless it has fistulized).  I would wait for the full post-operative recovery before making any rash decisions.  Even if you do decide to take the tube out, I would first seek a second opinion.

HV