Tears are produced by the lacrimal gland located in the upper outer corner of the eye and the tear glands in the inner corner of the eye. When we blink, they are spread across the eye to lubricate the entire surface and then drain into the nasolacrimal system through a narrow passage called the canaliculus. They eventually drain from the lacrimal sac into the nasal cavity at the back of the nose and throat and evaporate. This is why your nose runs when you cry or peel an onion. If the tear ducts are obstructed, you could have excessive tearing to
the point of tears running down your cheeks and interfering with vision. If left untreated, an infection in the lacrimal sac can occur; this infection is called dacryocystitis. Tears build up in this sac in the inner corner of the eye and bacteria start to grow, similar to a small pond that has gone stagnant. This can create painful swelling and redness that could spread from the eyelid/nose junction to the eyelids and other areas of the face. If you’ve been experiencing excessively watery eyes, it’s important to schedule a diagnostic test as soon as possible to check for an obstructed tear duct.
Obstructed or blocked tear ducts affect patients of all ages. In infants, the condition is usually caused by poor development of the nasolacrimal duct. The condition might improve by itself by nine months of age but if it doesn’t, then treatment may be required. Adults can also suffer from an obstruction caused by scarring, inflammation, chronic sinus infections, or prior injuries and facial surgery.
If you or your child are experiencing the following symptoms, you might benefit from tear duct repair:
- Tears that well up in the eyes
- Blurry vision
- Mucus discharge
- Eyelid crusting
The best way to determine whether you need treatment for obstructed tear drainage is to schedule a diagnostic test with Dr. Ghafouri. Personalized treatment plans will be made depending on your individual medical history and the results of your test.
Tear drainage repair starts with in-office testing to determine where the tear duct blockage is located. One of the most common tests is dilation or irrigation, which involves a cannula (thin tube) being inserted into the tear duct to irrigate the tear drainage system. You will be given numbing eye drops so that this is not a painful procedure. Another option is a dye test using fluorescein dye and blue light to illuminate the tear drainage passage. Additionally, a nasal endoscopy can be performed to investigate the nasal cavity and sinuses.
Once the cause of your tear drainage obstruction has been determined, Dr. Ghafouri will discuss your treatment options. One of the most common treatments is a surgical procedure called dacryocystorhinostomy (DCR) and it can be performed under general anesthesia or IV sedation with a local anesthetic. During the DCR procedure, a new site will be created to drain the tears directly from the lacrimal sac into the nose, bypassing the nasolacrimal duct obstruction in the nasal cavity. A small incision will be made on the side of the nose (external DCR) or inside the nose (endoscopic DCR). A temporary silicon tube will be placed in the new tear drainage pathway and will be left in place for 2-3 months. However, if there is significant scarring in the obstructed area, a permanent Jones tube made of Pyrex glass will be placed to help the tears drain properly.
Recovery after a DCR procedure only takes about 1-2 weeks. Mild swelling and bruising will occur, so it is important to avoid strenuous activity, swimming, and hot tubs for about 10 days. Be careful not to blow your nose for the first few days since this could cause a nosebleed. Dr. Ghafouri may prescribe a nasal spray or antibiotic eye drops and will give you a detailed list of post-operative instructions to guide you through your recovery.
Dr. Ghafouri MD, FACS, is a board-certified ophthalmologist with specialized training in oculoplastic and orbital surgery. His exclusive specialization in cosmetic and reconstructive eyelid and facial surgery sets him apart from other plastic surgeons who practice a larger range of facial and body surgeries. The eyes are a complex and dynamic structure that requires the trained eye of an eyelid surgeon like Dr. Ghafouri to achieve the best possible results. He has performed over 12,000 aesthetic and reconstructive surgeries, each with a personalized approach and commitment to exceptional results.Learn More
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