Tear Duct Surgery
Tearing in Adults
Excess tearing in adults may be caused either by poor tear drainage or an overproduction of tears.
Tears are produced in the tear gland. By lubricating the eyes, tears play a vital role in the maintaining the health of
the eye. When the eye is irritated excess tears are produced. People are not always aware of the eye irritation, but instead may notice the overproduction of tears.
Tears normally drain into small holes located in the inside corner of the upper and lower eyelids called puncta. The tears then collect in the tear sac. The tear sac lies under the skin between the corner of the eye and the nose. Next, the tears flow through a small tube, called the nasolacrimal duct, into the nose. The tears are pumped through this drainage system by the opening and closing of the eye.
A blockage in any part of this drainage system can prevent tear
drainage and lead to excess tears running out of the eye and
down the cheek.
It is very important to properly diagnose which part of the tear drainage system is blocked in order to determine the proper treatment. As part of the exam, a cannula might be placed in the tear duct, then the doctor then will attempt to flush water through the nasolacrimal duct into the nose in order to determine if the nasolacrimal duct is open.
In some patients excess tearing is caused by several different causes. Patients may have a partial blockage of the tear drainage system, poor pumping of tears because of eyelid weakness and excess tear production due to eye irritation, all at the same time.
Treatment of Tear System Blockage
When the nasolacrimal duct, the tube which drains tears into the nose, is blocked a surgical procedure is usually required. During this procedure, called a DCR (Dacryocystorhinostomy), a hole is created between the tear sac and the inside of the nose.
When the punctal openings are narrow or scarred, Dr. Perlman will often attempt to widen the opening by dilating them and removing a small wedge of tissue on the posterior surface of the punctal opening "punctoplasty". This can be a very simple and effective way to reduce or eliminate tearing in the appropriate candidate.
When the tubes, called canaliculi, which drain the tears into the lacrimal sac are blocked surgical therapy is more complicated. In some cases both a DCR and reconstruction of the canaliculi will be performed.
Eyelid weakness or malposition may be treated by surgically tightening and repositioning the lids.
DCR (Dacryocystorhinostomy) – Surgical Procedure
DCR is a same-day procedure. It is most commonly done under general anesthesia, but occasionally can be done under local.
A DCR is performed through a skin incision, which is made on the side of the nose. The bone between the tear sac and the nose is removed, and the lining of the tear sac is then attached to the lining of the nose to form a permanent drainage for tears.
In some people, during surgery, a clear plastic tube is placed from the inside corner of the eye into the nose. The tube is used to stent the tear drainage system and prevent scarring. This tube is easily removed in the office in a few months. Sutures are placed in the skin and removed in about a week. The scar produced will initially be red, hard and raised but will smooth out over the months after surgery.