Lacrimal Obstruction (Tearing)

Naturally the tears drain from the eye into the nose through the tear duct. When this duct becomes blocked the eyes tear. The treatment depends on the location of the blockage. It can be a simple procedure under local anesthesia or a more involved surgery under general anesthesia.   

What you should know about Lacrimal Obstruction

The tear drainage system begins with two small openings called punctum, one in the upper eyelid and the other in the lower eyelid. Through these openings the tears enter into small ducts called canaliculi, which drain into the lacrimal sac situated between the inside corner of the eye and the nose. The lacrimal sac opens into a canal called nasolacrimal duct that drains the tears into the nose.

(image – lacrimal system)

Approximately 7% of babies are born with congenital obstruction of the tear drainage system in one or both eyes. In adults, the most common causes are atmospheric pollution, medication, chronic nasal inflammation, allergies, chronic sinusitis or nasal trauma.

The symptoms are excessive watering, mucous in the eyes, eye irritation, and sometimes painful swelling in the inner corner of the eyelids (lacrimal sac abscess).

Treatment

In babies, the initial treatment involves massaging the area around the affected lacrimal sac to force the tears down the duct, and to push open the membrane causing the obstruction. This works in about 90% of cases. If the symptoms do not resolve by 9 months of age, a small office based procedure is necessary to open the membrane in the nose. After 1 year of age, the membrane can only be opened in the operating room using an endoscope under general anesthesia.

There are different treatments in adults depending on the location of the blockage:

Punctoplasty

When the opening of the tear duct (punctum) is blocked, a small office based procedure called punctoplasty is performed to open it. It takes about 10 minutes and is done under local anesthesia. There is no downtime and the patient can resume normal activities immediately after.

Intubation (Stenting)

An upper obstruction in one or both of the tear ducts (canaliculus) located inside the eyelids can usually be resolved with placement of a small silicone tube (lacrimal stent) in the natural canal, for a couple of months. This is done in the operating room under general anesthesia and takes about 30 minutes. The patient can go home a couple of hours later and resume normal activities the next day. The tube is removed in the office a couple of months later.

Jones Tube

A severe upper canalicular obstruction at the level of the eyelids can be solved by placing a rigid glass tube, called the Jones tube, in the inner corner of the eye. This will directly drain the tears into the nose. The permanent tube is generally well tolerated and does not cause discomfort. Rarely, the tube can get blocked by scar tissue or fall out. If this happens, an additional procedure to replace it will be required. Surgery is done under general anesthesia and takes about 45 minutes. The patient can go home a couple of hours later.

Recovery

Mild bruising might be seen in the corner of the eye. It will be necessary to use eye drops and nasal spray twice a day for a month. It is very important not to blow the nose for two weeks.

DCR

A lower obstruction in the nasolacrimal duct can be resolved with a dacryocystorhinostomy (DCR). This is the only effective long term treatment. It is done under general anesthesia usually using an endoscope through the nose. A new communication between the lacrimal sac and the nose is made to allow tears to drain. A silicone stent is usually placed for one or two months and removed in the office. The surgery takes less than an hour and the patient goes home the same day. 

Recovery

Mild bruising might be seen in the corner of the eye. It will be necessary to use eye drops and nasal spray twice a day for a month. It is very important not to blow the nose for two weeks.

Patients prefer endoscopic DCR to the external DCR because no skin incision is necessary, the recovery time is shorter and there is less postoperative discomfort. 

Why choose an oculoplastic surgeon

Oculoplastic surgeons are specifically trained for the diagnosis and treatment of tearing.