12 Weeks Out

Unfortunately over the past few weeks, I've started to experience high levels of tearing again, so this follow-up visit did not have good information to share with the doctor.  He knew from the start that I was having problems; he said first clue was the wad of Kleenex that I was holding ready in my hand.  During examination, he noted high levels of fluid in each of my eyes and observed that I had less than 20% success at this point.  He was very disappointed and after careful consideration made the comment that I had a couple of options at this point:  I could have the DCR surgery again and he could assure that I would see better improvement, or I could consider having Jones tubes inserted in the inside corners of each eye.  He discussed the "inconvenience" of the Jones tube, describing how I'd have to occasionally "blow out" (hold nostril and blow) the tubes and that I would have to have him clean them out once a year.  He didn't want to go that route, but said he needed to let me know that it was an option. He kept saying it was unusual that I didn't have better success rate in at least one of the eyes, as the average success rate is 90%, and given that I had both eyes done, I should have seen better improvement in at least one eye. 

He decided to remove the stents from each eye. I'm such a wimp, I stressed "how much will this hurt?" and his response was there might be a slight pinch but it would be brief.  Using long tweezers, he snagged the stent in my right eye, gave a quick twist motion and the stent was out.  No pain whatsoever - the stent slid right out before I even knew it.  The left eye went the same.  For some reason, I thought he was going to snip them apart in the corner of my eye and go up into my nostrils to pull them out.  Nope - his way made total sense and worked excellently!

He gave me the choice to come back in 2 weeks or call him and we would discuss surgical options.  I know that I have to do something to correct this tearing - it affects my daily life and I simply want to live without constantly wiping my eyes.   I agreed to call him and we would see where we go next.  He also put me back on my antibiotic nasal spray and ointment in my eye once each evening for about a week.

When I left his office, I was still tearing at an abnormal rate.  Two days later now, I find that the tearing has diminished significantly.  My eyes feel moist but tears do not fall as they've been doing for all this time.  Maybe we have progress afterall!

3 weeks post-op

It's been 3 weeks now.  I'm so pleased with how my recovery has gone.  My bruising has faded to the point that I'm not embarrassed to go out in public again, just little marks left around my cheekbones.  I feel good; there is little if any tenderness anymore, especially around my nose which seems to be where I felt it the most if I accidentally bumped it.  My vision is still not where it needs to be, but I'm able to see, just with a little more blurring than before.  I'm still using the antibiotic ointment at bedtime as I'm still seeing some swelling in my eyes. I'm also still using the nasal antibiotic spray each evening.  My incisions are incredibly nearly invisible. 

I'm still taking care not to blow my nose; I've given in to the urge a couple of times, only gently blowing it, but each time I've experienced small amounts of pinkish-blood in my Kleenex. There is obviously a reason I was warned not to blow my nose, so I'd better behave!  My doctor says this is only until the internal stitches are healed and stents come out. 

I've also been sneezing a lot - sometimes 5-6 times in a row!  Although I'm not completely conscious of it, there is a slight tickle up in my nose, most likely caused by the stents, and I think that is the cause.  The doctor had warned me to sneeze with an open mouth, so I've been following that advice (not very lady-like).    My nose feels stuffy a lot of the time...it is the change of seasons now and weather change always does that to me, so I blame the weather, not the surgery this time.

Post-surgical follow-up

My first follow-up appointment was scheduled for two weeks post-surgery.  The doctor actually seemed to want me to come in within a week later, but there simply wasn't time on his schedule.  We left the option for me to call if I felt something was wrong and he would see me immediately, otherwise we would follow-up at the first available opening.  That was on Tues, Sep 17th.  His nurse settled me in the examination room and ran me through a series of eye-chart tests.  I didn't do very well, and I knew that I wouldn't.

Once Dr. Michael came in, he carefully observed the surgical site, my eyes, my nose, and my general condition (bruising, etc.).  He asked me a series of questions about how I've been doing, checked whether I was still using meds he'd prescribed, whether I was experiencing tearing, and how I did with bleeding and pain.  I did mention that I'd had a couple of occasions of unexpected tears dropping, but it was no where near what I'd had pre-surgery.  He said his goal is to have no tearing.  He explained that the surgery had about a 90-95% success rate, and he wanted me to be one of those successes.  He asked about my vision, and I did explain that since the surgery, I've experienced a noticeable difference in my vision.  I haven't been wearing my contacts and my eyeglass prescription was a little outdated because I rarely used them, plus the fact that eye exams were always difficult given the amount of tearing that I was doing...I'd given up.  I know I need a new prescription for both glasses and contacts now, but I've decided to wait until all my follow-ups are completed. He agreed that I should wait until all healing was done. 

Small stents in place visible in corner of eye. 

He said my eyes were still swollen which will affect the vision.  I mentioned to him that I was totally surprised that the incisions were not on the sides of my nose, and he said that he intentionally placed them in the tear wells to help hide any scarring; he said in the long run it would be much less apparent.  He advised that I could begin using my contacts again and that it might actually help with minimizing the irritation from the stents. 

Dr. Michael advised that everything was looking very good for being only two weeks out.  He said to keep using the nasal spray and ointment, although I could cut back to ointment only at bedtime if I preferred.  We set our next follow-up for Nov. 12th (8 weeks out).  The stents will remain in place for now.

Day of Surgery and 1st Day of Recovery

On the early morning of 4th September 2013, I arrived on schedule to the Sacred Heart Outpatient Surgical Unit.  I was immediately taken to a small room with a bed, asked to gown up (I could leave my underwear on), and then settle into the bed.  Once settled, I underwent an EKG and had blood drawn for labs.  Both were done quickly and without incident by very efficient medical staff.  Shortly after, an IV was put in place on my hand, and a nurse began to monitor my vitals, including blood pressure, temperature and oxygen levels.  The nursing staff were all cheery folks with great personalities, which helped to keep me relaxed and entertained.  Before long, my anesthesiologist came in and asked me a series of questions.  He advised that he would be inserting a tube into my throat just before surgery so that they could manage my breathing and he said that I might come out of anesthesia with a sore throat, but that he didn't anticipate any problems. While he was talking to me, my surgeon came in to check with me and also wanted to to see if I had any questions.  I totally appreciated the personal visits by both and I knew I was in good hands.  As soon as they left the room, the anesthesiologist's surgical assistant came and advised he was going to do some final prep and then move me to the surgical unit.  He let me know he was going to give me something to relax me while he moved me, and warned me that I should be feeling that soon.  He and one of the nurses started pushing the bed into the hall and that was the last I remembered.  Anesthesia is magical!

I woke up in recovery about 4 hours later with a nurse by my side trying to get me to talk to him, and advising mat everything went great.  Every few minutes he would speak to me again, and before long, I was able to focus and remember where I was and what I'd just been through.  After a short time, he and another nurse moved me back to my initial room, where my daughter was waiting for me.  I was pretty sedated, but remember that there really wasn't any pain.  At one point, I said that I was surprised that my eyes weren't covered and the nurse said that they weren't going to cover them...the doctor wanted the incisions exposed for better healing.  Dr. Michael came by and told me that everything went well, although he'd had a tougher time with my left eye than my right, but it went good.  I asked what that meant, and he said that it wasn't anything bad, it just took him longer to get through.  He reminded me that I'd undergone "a lot of surgery" and that I likely would be needing to stay with the pain medications for a couple of days, but more importantly, he wanted me to be sure to stay up on my antibiotics and steroid ointments.  He said I could go home as soon as I felt steady enough (which I already was feeling), but he suggested I eat something light soon just to keep me from experiencing nausea from the anesthesia.  He had a nurse bring me a juice and applesauce.  He gave me his personal cell phone number and said to call him immediately if I had questions, concerns, excessive bleeding or pain.  My instructions were to go home and sleep for the rest of the day.  Use ice packs for 10 minutes every hour to help reduce swelling and bruising.  Ointment in each eye and on the stitches morning and night.   Oral antibiotic morning and evening. Nasal spray (antibiotic) morning and evening, plus Afrin nasal spray for use only to control nose bleeds (addictive, I was warned). Pain meds every 4 hours as needed.  No blowing my nose; I could sniff, snort and spit if I felt the need, but I was definitely not to blow my nose.  I could expect to see blood when I spit but I should not have significant bleeding.  I could expect small spots of blood from my nose, but I should report immediately if I saw significant bleeding.  I should probably try to use two pillows or sit slightly up in the bed while sleeping, or sit in a reclining chair.  No bending or lifting for 48 hours.  No driving for 36 hours. I had no food restrictions.  Showers okay after the first 24 hours, but take care that the water doesn't spray onto my face. I should resume my blood pressure med the next morning and any vitamin, low dose aspirin and other nutritional supplements after 24 hours.

My daughter said that I chatted with her during the 30 minute drive home, but I recall very little of it.  I do remember finally pulling the visor mirror down and looking at my eyes and was totally startled by the bruising around my eyes.  I looked like I had been in a bar fight, plus my eyelids were pretty swollen and red.  But what was the biggest surprise to me was that I didn't see stitches where I'd expected them to be.  From all that I'd read online about this external DCR, surgeons typically made incisions on the side of the nose.  My surgeon did his incisions along the "tear well" under the eye, the natural line that follows the orbital bone.  I was amazed at the precision of his stitches...I could actually only see one or two stitches with each incision; the others were simply done in a way that they were not seen.  As painful as everything looked, I wasn't in pain.  I attributed that to the fact that I'd been medicated up during surgery and decided to follow the doctor's advice on being sure to "stay ahead of the pain", so took a pain pill at the time he advised me to, then went to bed and slept for about three hours.  When awake, I began doing the ice applications he'd suggested.  During recovery at the hospital, the nurse had brought me two tube-shaped disposable ice bags that I'd brought home with me which I continued to use.  One of those with ice was perfect for laying across my eyes.  The doctor had suggested using putting Karo syrup in a baggie and freezing it for a while to chill.  I prepped such a bag, but while it was mold-able and really held the cold without solidifying, I preferred the ice bags.  I followed the regiment of 10 minutes icing per hour for the first couple of hours, but found later that the ice applications helped me control the feeling of pressure and minor pain.  By the second day, I was using mostly ice treatments and Tylenol during the day, preferring to endure the doped up feeling the pain meds gave me.  I did take a pain pill at night.  Again, I had discomfort, but very little pain, actually.  While no external incision was visible on my nose, my nose was swollen and I experienced pain if I accidentally bumped it - obviously some surgery was done beneath the skin and I quickly learned to work around it as gently as the visible incisions.   I also had an area above my right eyebrow that was quite tender to the touch; a small bruise was there too, but I figured it was from something done during the procedure and not a surgical area itself.

On close examination, I could see very small silicone stents looped into each tear duct.  

Best of all...no tearing.  

5 years of excessive tearing

I am just healing up (2 1/2 weeks out) from having DCR surgery to correct blocked tear ducts in each eye.  My condition of blocked tear ducts which caused excessive tearing was a problem that came on slowly.  As best as I can recall, the tearing started nearly 5 years ago.  I would be in a conversation with friends or making a business presentation and unexpectedly, large tear drops would overflow my eyes and hit my cheeks.  It didn't happen often at first and I guess I always figured my eyes were reacting to makeup, contacts, dry heat - never once did I think that I actually had an abundance of tears that could not drain.  My boss told me that I didn't blink enough, friends and co-workers insisted that I probably had some type of allergy,  I decided that I could live with it and so I did.  One year turned into two, my life suddenly got hectic between work and family, and by the third year, the incidental tearing had become a regular problem.  I found myself experiencing chronic tearing and considerately moist eyes that affected my ability to keep my contacts clean.  Optometrists were no help - they would confirm that my eyes had layers of tears that wouldn't drain and generally all wanted to treat me for "dry eyes". I tried drops, I changed types of contacts, I changed contact solutions, I used hot compresses for days on end, I stopped wearing mascara.  Nothing reduced the tearing...in fact, the amount and occasion of uncontrolled tearing increased steadily.   My medical doctor determined that the problem was not allergies or a treatable medical condition and finally in the fourth year referred me to an Ophthalmologist.   After a considerable wait to get in to see the Ophthalmologist, I had my first in-depth discussion with an eye expert.  After a thorough exam, she finally advised that she was going to try to dilate the tear duct openings, and next thing I knew, she had a metal probe in her hands and was advising me to lean back and try not to move.  She then proceeded to poke into one of my tear ducts and apply more and more pressure to the point that I simply couldn't stand it anymore.  It wasn't that painful, but felt like a bee sting that wouldn't end, as long as she was probing.  I just couldn't take it for long periods of time.  Finally she advised that she wasn't able to go deep enough with her probe and that it might be best if she had me come back and she would sedate me next visit so she could be more aggressive.  I agreed to make a follow-up appointment.  Unfortunately that appointment never came.  I had a death in the family and my personal situation changed, including a move from one state to another,  I finally began the process anew earlier this year with a local Ophthalmologist.  My new eye doctor wanted to do the same type of probing that the first one had tried, only this time, she numbed my eyes before attempting to probe.  She also attempted to use a syringe to shoot a yellow solution through the tear duct, but was unsuccessful in getting it through either eye.  After a few more tests, she finally diagnosed blocked lacrimal sacs and explained that she was going to refer me to an orbital plastic surgeon to discuss the option of dacryocystorhinostomy (DCR) surgery.   I met with Dr. Kevin Michael of Spokane, WA, in early May.  Despite the referral from my Ophthalmologist, he went through his own process of probing, trying to push a syringe of solution through my tear ducts, etc., before determining that indeed I did have complete blockage in both tear ducts.  He said that I had a couple of options for surgical correction, but his suggestion was that I undergo external DCR, starting with one eye and following up after that one healed to correct the other.  After we discussed what the surgery would entail, I advised Dr. Michael that I would prefer to have both eyes done in the same surgery; especially since the surgery involved anesthesia.  Although he expressed concern about trying to do them both in the same procedure ("That's a lot of surgery..."), I was adamant that I preferred to have it done that way.  He finally agreed and we worked out a surgical date well in advance, agreeing on early September.  In the meantime, Dr. Michael had me use steroid drops in both eyes and asked me to advise immediately if I noticed any change in my tearing.  No change occurred.

Throughout the summer, I couldn't resist going online and researching this surgery that I was about to undergo and I can truly say what I read by others who had been through it and watching a YouTube video of a similar surgical procedure (I suggest you refrain from doing that!) - all which scared me completely and made me doubt my decision to go ahead with the surgery.  I had started to talk myself into thinking the tearing wasn't so bad, but then as I got through the day with constant wiping of my eyes, and blurred vision from the layer of tears laying on my contacts, I knew I needed to do this and hoped for the best.

I was advised to quit taking my low dose aspirin two weeks prior to surgery, and to stop my blood pressure med, vitamins and other nutritional supplements no later than the day prior to surgery.