When I wrote my last post, I had no idea that I would find myself needing every one of those words the very next day.

But first, let’s back up a bit.

So for the last year and a half, I’ve worn duct plugs.

It’s a really fun phrase to say over and over out loud – try it.

Giggling now? Good.

Duct Plugs.

One of the most annoying symptoms of Dysautonomia is severely dry eyes – to the point that no drops can help it. On top of that, I’m limited as to what drops I can put in my eyes, so really – nothing helps.

Except for Duct Plugs.

They’re fantastic. They’re like tiny bathtub drain stoppers that are inserted into the tear duct on my lower eyelid to keep my tears from draining and, therefore, perfectly solving my dry eye issue.

I got my first pair of duct plugs the summer before last. About a year later, they fell out. My eyes had been burning and making me feel ridiculously sleepy, and it occurred to me to check my duct plugs (because you can see the tiny little things sticking out of your eyelid,) and alas – they were gone.

(Let’s take a minute for everyone to go find your tear ducts. Look in the mirror. They’re on the top side of your lower lid, on the nose-side of your eye. You have tiny holes just waiting to drain your precious tears away. They’re quite useful – unless you suffer from an eternal draught. Now. Think of the biggest pore plug/blackhead that you’ve ever squeezed out of your nose, except envision it made of rubber and shoved into those tiny ducts. That’s what my duct plugs looked like. Are we together now?)

I called to make an appointment with my Ophthalmologist (the receptionists all passed around my call so that everyone could hear me ask for new duct plugs), and when I went in for my appointment, he told me what I had previously not realized – duct plugs falling out was expected. In fact, my duct plugs lasted a lot longer than most. He said he’d put the next bigger size in, and hopefully they’d last a while. But it turned out, those were still too small, so he gave me the BIGGEST size of duct plugs available.

(I have big ducts. And I cannot lie.)

He explained that our next step, when these duct plugs left me, would be permanent duct cauterization – it was a great solution, but insurance didn’t allow it until you’d lost a pair of the biggest duct plugs.

So I happily left with my XL Duct Plugs, snugly keeping my tears in Eye Lake.

Which brings us to this week.

Again, I began feeling infinitely sleepy, eyes burning, lethargic, the whole deal. You just don’t realize the debilitating nature of something so simple as dry eyes until your eyeballs are withered raisins, and then wow do you ever.

I made my appointment for duct cauterization (so much nicer to request than duct plugs), made sure I wouldn’t need anyone to drive me home, and anticipated eyeball moistness once again.

I dumped my kids on my neighbor and headed in.

My Ophthalmologist came in and checked out my one remaining duct plug. I asked him to go ahead and pull it so I could get this cauterization thing over with in both eyes. He looked at me skeptically, but agreed to do so. He yanked it out, examined my eyes some more, then said,

“Do you think you can do this without a pain injection? Because the injection is really just as bad as the procedure itself.”

I thought of the all the things I’ve let my Physical Therapist do to me in the past six weeks. I’m tough. I can handle whatever my Ophthalmologist throws at me.


I’ll be fine, I told myself. He wouldn’t offer to do it without the pain shot if it wasn’t a viable option.

The doctor left the room, then came back with paperwork that I had to sign, acknowledging the permanency of the procedure, and with a pen-sized blowtorch.


While the door was still open, the nurse walked by and said, “I’ll be right out here if you need me…”

I raised an eyebrow. “That sounded ominous.”

The doctor laughed. I was not sure how to interpret his laugh, but I was pretty sure I didn’t like it.

He told me to lean my head back, and he stuck the tip of his cautery gun on my eye duct and turned on the zapper. I jumped slightly, as one does when a red-hot piece of metal touches their eyelid.

He pulled back. “Did you feel that?”

“Yes, but I can take it. It wasn’t horrible.”

“Hmm. I changed my mind. I want you to get the injection because I want to be able to really get in there and burn it good.”

He disappeared again and came back with an unholy-long eye shot.

He again told me to lean back, open my eyes as wide as I could, and look at the ceiling. He pulled back my eyelid and stuck that needle through the inside of my lower lid.


We have SO MANY NERVES in our eyelid. SO MANY.

The needle went into my eyelid and felt like it was coming out of my right nostril. He jammed that thing all up in my face. I felt the cool liquid of the numbing medication trickle into my sinus cavities from above, and it made me desperately need to sneeze.

But alas. There was three feet of needle in my eye. This seemed like a bad time.

“Keep your eye open!”

(I would have answered “I can’t!” but I couldn’t move without moving the needle in my eye.)

“Are you okay?”

(I would have answered “Are you kidding?” but I couldn’t move without moving the needle in my eye.)

He finally pulled it out, then walked around to the other eye.

WHOSE bright idea was it to get both eyes cauterized on the same day? I should have kept that precious duct plug as long as it agreed to stay in.

It was unbelievable. The pain from the injection was definitely that red crying face from the pain chart, and worse if such a thing exists (a crying poo emoji? Yes. A red crying poo emoji.)

Pain Assessment Tool Poo Emoji

(And as a reminder, this is coming from the person that has happily let her Physical Therapist stick her dozens of times in the past six weeks in the neck, shoulders, leg, and head.)

But I somehow survived.

He told me he’d be back for me when I was numb, and happily walked of the room, leaving me to tend to my gaping eye wounds.

I dabbed. I thought about crying but figured it’d hurt too much. I dabbed some more and realized I couldn’t feel my dabbing anymore. At least that seemed like a step in the right direction.

He came back and had me insert my head into the head brace so he could “get a really good angle.”

He got out his burny tool and inserted it deep into my left eye duct. Pressed the button, heard the electrical burning sound, then the frying/boiling of flesh, then a poof of smoke shot up directly in front of my eye. I guess that was his cue that cauterization had occurred, because he retracted his eye branding gun and stuck it down into my right eye duct.

Button, burn, boil/fry, poof of smoke, retract.

Seeing the poofs of smoke caused by the frying of my live eyelid skin made me thankful for those Son-of-a-Motherless-Goat Shots from Hell.

Each eye took maybe three seconds.

But after he finished, THEN he found it to be the right time to say,

“Oh by the way. Just so you know, the cauterizations will probably open back up at some point. But the good news is, we can do this as many times as we need to!!”

I looked at him incredulously. He did not look like he was being ironic.

The paperwork. Our conversations. Everything had indicated that this was it. The Holy Grail of duct closure. A vasectomy of the tear drain. AND NOW HE’S GONNA TELL ME I GOTTA DO THIS AGAIN AND AGAIN AND POSSIBLY AGAIN.


I said in my most biting tone, as I tried to hold my recently char-grilled eyes open, “You know what, let’s go ahead and schedule ourselves a monthly date.”

As I got in my car to drive away, the numbing shot quite immediately wore off, and I began to feel the third-degree burns in my former eye pits. I fought to keep my eyes open, thinking angry thoughts about the receptionist who told me I wouldn’t have need for a ride home.

But I made it.

And for now, at least, my ducts are closed for business.

Appendix: if you want to see the procedure, I found a very accurate and short video here. Except that my doctor definitely did believe in inserting the cauterizing gun into the puncta. And also if you see me this weekend and I appear to have a black eye, please compliment me on my stellar eye shadow job.

18 thoughts on “In the Collecting of Obscure Medical Procedures…

  1. Wow. You put me in the moment to the extent that I realized I was doing a shallow breathing thing I do when I’m having insufficiently anesthetized dental work done. Hopefully, the cauterization will last as long as a (good) vasectomy.

  2. Ow ow ow! I had to have a shot of lidocaine in a very sensitive area after having baby # 3. It went into my blood stream and made my heart race. Nasty stuff. Owie.

  3. I think I am in severe pain from reading. And to think I complained about a shot in the ear. So many prayers for you and all you are going through. I shall now go throw up.

  4. Wow. I’m so sorry you had that experience. On the bright side, I had so much fun reading portions to my husband after he asked about the horrified look on my face (while I was reading your article).

    1. That’s good! Everyone else seems queasy. I need someone that had fun with it or it means I didn’t wait long enough to blog about it so that I could make it appropriately entertaining! :-)

  5. I’ve also had a sensitive part of my body cauterized & all I’m going to say is, IT IS NOT OKAY.

    And it is not okay to drive after being cauterized! Cauterize the receptionists because they don’t know.

    Let’s start a hashtag campaign #HumansAgainstFleshCauterization

  6. As an optometry student who just finished a rotation with several ophthalmologists (oculoplastics included), I am dying laughing at this post. It’s great to hear a detailed version from the patient’s perspective. I’m surprised he attempted the procedure without anesthetic, I’m sure that was very painful. The drainage holes are called puncta, and thus punctal plugs. Cauterizing the puncta and duct is fairly permanent and not performed unless blocking the drainage system permanently is wanted. Maybe they can use a smaller needle if there is a next time.

  7. Whenever I’m going to get a procedure done I like to watch as many videos as possible. I don’t know if it helps, but I enjoy it. My son is getting his nose cauterized on Tuesday, I should go look that up.

  8. Good lord woman! I did not know such a procedure existed! I’ve had blood vessels in my nose cauterized due to severe nosebleed and that hurt like hell. I cannot imagine having it done on my eyes. You have taught me things I did not know I needed to know.

  9. I’ve had this done!!! The weirdest part was smelling my burning eye-flesh. Gross. My right eye makes no tears so I had a plug and they cauterized it in maybe 2008? I’ve had no problems (and it hasn’t opened up or anything!)

  10. OMG!! Eye procedures are the worst. As someone who’s been evaluated multiple times for lasik and now lens replacement I feel your pain! I couldn’t help but laugh as you were describing the smoke in front of your eyes and think of the Cosby sketch about going to the dentist! Glad you are okay and hope you never have to get it done again! blech.

  11. Oh Rachel. Ohmygoodness. That is the worst thing I’ve ever heard. I’m terrified of needles. Nurses have to hold my kids when they get them because I actually blacked out once while B was getting her shots. I couldn’t even read all of your post! I hope your csuterization lasts forever and ever and you never have to do this again! Ugh..I’m feeling faint just thinking about it.

  12. OK… this I COULD NOT DO without general anesthetic. Im pretty sure. I would keel right over. Wow.
    Also… have you seen the “pain chart” on Hyberbole and a Half? Its stinking Hysterical! Just a warning though.. there is a bit of language… but my stars. I was gasping for air I was laughing so hard!

  13. I actually had to put my phone down while I was reading this and “I can do this….I can do this…I CAN finish reading this!”

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