blocked tear duct surgery

[ian anderson]

hi anyone had a blocked tear duct and then had surgery to fix? let me know im going in for it thanks Ian

[Jack]

Had blocked tear ducts for a long time with tears running down my face, but decided not to go with the surgery. It went away of its own accord after a few years.

[Lola]

I have a history of very, very dry eyes, which present as constant tearing eyes. A helpful opthalmologist offered to put plugs in my tear ducts to prevent the tears from washing away. No, thanks!

[elephant]

About five years ago I had dry eyes and used restatsis....that worked...but I don't use it anymore and my eye's are not dry. I think once your wegeners is better controlled then it will get better. It depends how much damage has occured in the tear ducts. The eye doc wanted to put plugs in my tear ducts too..

[pberggren1]

I had it done a year ago on my left tear duct.

It didn't work at all and leaves me with some pain on the left side of my nose now and then.

I will probably never have it done again. The doc that did it said that he may have to do it 3 or more times before it takes and he said also that it may never take. So I just put up with the runny eye.

[Lola]

I've used Restasis, as well. I'm not sure if it helped or not, because my dry eyes tend to just happen now and then, but they ARE a pretty good indicator of a flare coming on. Currently, the eyes are fairly normal, I just need to blink more often.

[ian anderson]

does it leave you with bruising? and can you see the scar it left? i get a lot of puss its so annoying i really want it to go do you think its worth the risk thnx ian

[me2]

I had a DCR (dacryocystorhinostomy) done about 15 years ago because of repeated eye infections due to blocked drainage. The infections were terrible. My whole eye would swell shut and then the infection would blow out through the skin below my eye to drain.

It has worked well , even through recent years of WG flare. Unfortunately I am now having the same problem on my other eye, without the bad infections. So, I am asking questions about this same topic of myself.
I went to see an eye doc recently and was told that the surgery was still done the same way as when I last had it done. I was not thrilled to hear this because the surgery I had done (the DCR) was not minor.

After coming home and thinking about what the doc said I got online and found that there is a less invasive procedure that is endoscopic. I don't know why he didn't mention it to me and suggest it as an alternative. I am seeing my PCP next week and I am going to ask more questions about these different procedures and how I can determine what would be best for me. I will let you know what I find out.

The surgery I had done years ago, the DCR, involves a large incision next to the nose and then drilling a hole "about the size of your thumb" through the bone of the face next to the eye. (the scar on my face is truely not visible. People don't notice it unless I have them specifically look for it. The surgeon said this part of the body is very forgiving for scars. That was certainly true with me.)

The endoscopic procedure uses a laser to make a small hole and does not cut into the skin on the face. The youtube video I watched on the procedure said the success rate was something like 50 to 90 percent. Well, 50 percent doesn't sound great so this is something I would like to discuss with the right doctor also.

Best of luck,
Kirk

[ian anderson]

thanks kirk for your very informative message on your eye surgery wow that was quite a procedure you had but i do need something to be done im at the desperate stage im having to wear dark glasses because my eyes are always running with puss i"ll look into micro surgery as well thanks again
your fellow weggie ian

[elephant]

Ian, It took over a year for my left eye to stop from oozing, had tons of eye drops and I think once I was put on 60 mg of prednisone it stopped...so I think it was the wegeners flaring at that time. It is much better today.

[me2]

Hello Ian,
I'm sorry you are having such trouble. With my recent trouble with my left eye I also woke up one morning recently and went to town and someone said "How did you get a black eye?" I said " I don't have a black eye, its just my eye oozes sometimes" He said NO , you have a black eye.
I looked in the mirror and it did indeed look like someone punched me. So I went to a little walk in clinic in town and the doc there said the black eye was due to inflamation from an infection and put me on Bactrim - two Double Strength pills per day for ten days (a horse dose). And, eye drops of Sulfacetamide 10%. She cultured the ooze and it had a common bacterial bug in it.
I tried it for a few days and was thinking "This isn't going to help, this eye has been oozing for months and none of my other doctors thought they could help". Well, after about the fifth day, it cleared up. For the first time in months I was free from ooze. I had even been having a little ooze in my good eye and it cleared up too.
It stayed cleared up for almost a couple of weeks and now is creeping back to its former condition. Of course, I cannot keep repeating horse doses of antibiotics. It was great to know that it was an infection and not WG causing my problem (I was assuming it was WG) and that I can have it fixed with the surgery when I am ready. The recent eye doc reminded me that it had to be NOT infected to do the surgery, so I am aware that I'll have to do the antibiotics prior to surgery.
I had two different doctors tell me that the eye drops are largely ineffective , that it is the oral pills that clear up the infection. Personally, I like using the combo.
I like that I got the ooze cultured and found out exactly what bug it was in my eye AND I like that the doc put me on antibiotics before waiting to get the results. It turned out to be a good choice of antibiotic (I have FEW choices, but thats another story) and the culture was a good way to confirm that. It also confirmed that it was not WG causing the oozing, like elephant has had (which I have had before also)
Best of luck to you Ian, one pus eye to another - Kirk

[Jack]

Many of us here take Bactrim on a daily basis to ward off stuff like this. It worked for me and stopped many of the irritating little infections that I used to get. Sometimes I have to switch to something else if I get attacked by something that is immune to Bactrim.

[me2]

Good point Jack. Me having WG I knew Bactrim might help with other things.
I have taken Bactrim for long periods of time. I have used it to treat sinus infections that I used to get a lot.
I WAS allergic to Bactrim way back when. At one of the Vasculitus Foundation events many years ago I got to meet the doctor , Dr DeRemee, who had then recently discovered the connection between staph infection and WG relapse- hence the prophalactic use of Bactrim (for Staph) for WG patients currently.
I told him at the symposium that I was allergic to Bactrim and he suggested that try the components of Bactrim seperatly and see if that might help. Well, the internet having been recently invented, I did research when I got home and found information on desensitization to Bactrim for AIDS patients suffering from infection.
I printed out the info and took it to my regular doc (along with my latest sinus infection). He gave a long talk about infection and got ready to write me a script for the latest and greatest antibiotic and I interrupted him and said "I have another option I'd like you to take a look at".

He read the material quickly and said "This sounds like a better idea, lets get you started".
Desensitization works in 80% of cases so I knew my odds were good.
Within a short time I was able to take Bactrim and it has been a real help to me.

[Sangye]

Wow, that's really cool info. It seems like Bactrim only helps Weggies with upper respiratory involvement to prevent relapse. I don't know if I read that somewhere (ie, from the Wegs specialists) or if it's just from what I've noticed. I wonder if it depends on the person having more vasculitis vs granuloma type of Wegs.

I never heard about the desensitization part, either. Great post, Kirk! :)

[Jack]

If you are allergic to Bactrim it can tear you up real bad, even kill you! For this reason it has been withdrawn in some countries. You soon know if you have a reaction because you break out in sores, the trick is then to take notice and stop taking it! (or maybe desensitise yourself as mentioned above, but I don't know anything about that)

[me2]

As I remember the desensitization was a liquid that the pharmacy made up. This was all done through my doctor.
You start with a VERY small amount and gradually take more. I forget how long it took , I think maybe a couple of weeks or so , maybe three. Eventually you reach a theraputic dose and hopefully have not had a reaction. I remember that it worked without a hitch for me.

I used to have no allergies. After years of heavy antibiotic use for sinuses and my eye I gradually became allergic to more and more of them untill I had very few choices. It was great to get Bactrim back on my list, especially with its special place in Wegener's treatment.
Dr DeRemee told the story of how he became curious about the connection between Bactrim and Wegener's.
He had a patient come in with Wegner's symptoms and an infection. Apparently the infection was bad because he said he had to treat the infection first and only after that treat the Wegener's. He used Bactrim. Much to his surprise the Wegener's cleared up too. Being knowlegeable about Wegener's he knew that it doesn't just 'go away' and began to investigate why Bactrim cleared up an infection AND Wegener's.
Bactrim was even considered as a hopefull first line of treatment for Wegener's.
It was found not to be effective as a first line treatment. How amazing though that it worked at least that one time and that Dr DeRemee was sharp enough to catch the connection and that it led to studies about its usefullness in preventing relapse.
Sangye, I don't know about it being targeted to specific conditions of Wegener's, I haven't heard of that before, but I'll bet you are right. I'm guessing this because I'm thinking that staph is maybe most often respiratory and so many of us have at least some sinus involvement. I dunno.
Jack, I have only had mild allergic reactions , your post is a reminder to me that I shouldn't always assume a mild reaction. I didn't know Bactrim was withdrawn in some countries. Too bad , it seems very useful here. Perhaps it is most dangerous in countries where there is not a good connection between a doctors care and availability of the drug. I dunno.

[elephant]

HEy me2, great info...I take Bactrim every other day. I also take it when I think I have a sinus infection. I would love to have the info on desensitization just in case I need it.

[me2]

Hi Elephant
I am so gratefull for the many times I have been helped by other Weggies I'm glad to know that some of what I know might be helpful. So many times I read about others plight and I don't have direct experience or knowlege and feel rather useless to help. Finally something I know a little about comes up , goopy eye and Bactrim. ha
Here is a good web site I think that explains just about every thing you could want to know about desensitization to Bactrim:
Sulfa Desensitization (http://www.aids-ed.org/aidsetc?page=cm-1001_sulfa)

It has the same info I remember from many years ago and then some. I notice that they have the warning like Jack made about the potential for a serious bad reaction. I don't remember knowing that when I did it.
I see too that they say if you quit you might have to do the desensitization over again. I had not seen that mentioned before either. I personally have quit and restarted Bactrim many times over the years with no ill effect. In fact I took some about a month ago for ten days and I plan on taking some again soon for goopy eye that is plugged up. Take care.

[elephant]

Thanks so much me2, you are very helpful. Everyone on this forum is informative..just their experience helps everyone on this forum....understand this disease a little bit more!

[pberggren1]

Kirk,

I never knew about the endoscopic approach using a laser. I think I will mention it to my local Opthamoligist when I see him in September.

Thanks Kirk

[Lola]

Thanks, Me2 for the excellent information. I had goopy eyes, as well, for 2 years before I was diagnosed with WG. I was started on Bactrim DS daily, and CellCept. Now that I think of it, my eyes cleared up without recurrence. Of COURSE it was the Bactrim.

Your information on the surgery is amazing. I'm sorry you had to endure so much. I hope you can be helped, Ian. Sounds like you really need for some kind of intervention.

[me2]

Thanks Lola,
Another member of the goopy eye club. ha. I am concerned for Ian too.
I was going to talk a little more about the surgery - the DCR I had. I think you picked up that it was quite traumatic for me, and it was. I think there are two reasons I had such a difficult experience.
First, the recovery nurse was really quite mean and insensitive to how much pain I was in and I had no one there to be my advocate.
Second, I had terrible neausea, I mean really Biblical (ha) - beyond description. This was from the aneasthetic.

Recently I had hernia repair surgery and I was frankly scared to have a repeat of my DCR experience. I told my doctor and the aneasthesiologist about my concerns and I was told that aneasthea had improved a lot since my last surgery AND that they would take good care of me after the surgery. Man, were they ever right. I had zero nausea and the nurse in recovery was VERY attentive and kind. AND she kept asking me how I felt, if I said it was hurting at all then I was given a little zap of pain killer. It was really a good experience. Plus I had a relative who is a nurse there as my advocate. (turns out she wasn't needed. still I would have here there again, you just never know) The pain killers were so effective I was sent home the same day.

So, I'm thinking that even if I get the DCR done again it would not be so bad as last time. I would go in expecting the same treatment as I recently got for hernia repair.
Also, strangly enough, the day after the DCR I felt zero pain and felt zero pain for my entire recovery after that. I don't know if that is normal but I take that memory with me too. I have heard stories from other people too about how much easier surgery is now days so it is very encouraging.