Tear Duct Surgery in Phoenix

Written by Dr. Ali Ghafouri

Also Serving Patients in Scottsdale

TEAR DRAINAGE (NASOLACRIMAL SYSTEM) OBSTRUCTION

ANATOMY:

The tears are produced by the lacrimal gland, which is located at the upper outer corner of the bony eye socket and also numerous smaller glands inside the eyelids. These glands produce tears, which keeps the eye moist and lubricated. The tears drain from the eye through a small hole in the inner corner of each eyelid called punctum. When we blink the tears are pushed to the inner corner of the eye where by its pumping mechanism, the tears drain into the nasolacrimal system. The tears then move through a very narrow passage called canaliculus and then into lacrimal sac. From there, the tears drop down to a narrow duct called nasolacrimal duct, which is located inside the nasal cavity. The tears drain into the back of the nose and throat where they evaporate. This is why your nose runs when you cry or peel an onion.

SYMPTOMS:

Symptoms of obstruction of the tear duct include excessive tearing, tears running down the cheek, tears welling up in the eye and interfering with vision, mucus discharge, and crustation of the eyelids.

If the obstruction is not treated, there is chance of developing an infection within the lacrimal sac (dacryocystitis). It is a like a pond or a swimming pool where the water has been stagnant foe a long period of time and then different types of bacteria starts to grow. It presents with painful swelling and redness in the corner of the eyelid /nose junction. If it goes on untreated, this infection could spread to the eyelids and even the face.

CAUSES OF THE OBSTRUCTION:

An obstruction may occur at any point along the nasolacrimal drainage system. In infants, it is usually due to congenital lack of development of the distal potion of the nasolacrimal duct.

These patients present with symptoms of excessive tearing and mucus discharge. It may require probing and irrigation procedure if it does not resolve by nine month of age, but frequently it resolves on its own.

In adults, the nasolacrimal obstruction may be caused by scarring, inflammation, or infections within the sinus and nasal cavity. Any chronic sinus disease, nasal/sinus surgery or facial fractures may predispose to the nasolacrimal obstruction. Rarely, it may be caused by tumors, systemic inflammatory conditions, stone, radiation, and chemotherapy. However, the most common cause of tear duct obstruction in adults is due to closure of the nasolacrimal duct with no underlying or predisposing factors.

DIAGNOSTIC TESTS:

There are a number of diagnostic tests and office procedures performed in order to investigate the tear duct obstruction. These tests are crucial in finding out the exact location of obstruction.

One test commonly performed to evaluate excessive tearing is dilation/irrigation. The eye is first numbed using a numbing eye drop and then the tear drainage is dilated using a probe and then a cannula attached to the syringe is inserted into the tear duct and the tear drainage system is irrigated with a saline solution. In dye test, a fluorescein dye is placed over the eye and tear drainage and its pathway are illuminated using blue light.

Frequently a nasal endoscopy is performed to visualize the nasal cavity and the sinuses to further investigate any possible pathology accounting for obstruction or delayed drainage of the tears.

TREATMENT:

A treatment plan is individualized based on the patient’s history, examination and diagnostic tests. The most frequently performed surgical approach for an obstructed tear duct is dacryocystorhinostomy (DCR). This procedure is routinely performed in adults with acquired obstruction of the nasolacrimal system. It is performed as outpatient under general anesthesia or just with IV sedation. In this surgery, the surgeon will create a new site for the drainage of the tears. The tears will drain directly from the lacrimal sac into the nose thus by passing the obstruction. A small incision is made in the skin at side of the nose (external DCR) or inside the nose (endoscopic DCR).

In all of the above procedures, a silicon tube is placed temporarily in the new tear drainage pathway. The tube makes the loop from the corner of the upper to the lower eyelids (through the punctum and canaliculus) and then hangs in side the nose. It prevents the scarring and early closure of the new tear drainage. The stent is kept in place for two to three months. The tube is easily removed at the office with little to no discomfort.

If there is any significant amount of scaring where it cannot be opened, it may be necessary to place a different type of tube called Jones tube. This tube is made of Pyrex glass and permanently remains in the tear duct.

Possible risks of the surgery include small scarring from the incisions, occasionally scar tissue may develop at the opening that was created later causing blockage, which may require repeating the procedure. As with any type of surgery, there is always risk of bleeding and infection. Please contact Arizona Oculoplastic Specialists for more information or to schedule a consultation.