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Lacrimal (Tear Duct) Surgery

Everyone produces tears. Their function is to lubricate and nourish the surface of the eye. They also help sweep away debris, including mucus, dust and foreign material. Having a healthy tear film on the surface of the eye is important to maintaining healthy eyes and vision.

Just as everyone produces tears, everyone has experienced tearing. It is a normal response to have tear overflow (tearing) with a strong gust of wind, in a cold or dry environment, when dust or foreign bodies get in the eye, or even simply when crying.

However, some people have tearing beyond these situations where the tearing affects their daily living or is a source of embarrassment. When this is the case, your eye doctor will try to uncover the problem which is usually one with tear production or tear drainage. In some circumstances, it may be a combination of both.

TEARING AS A SYMPTOM OF DRY EYE SYNDROME

Your tear film is composed of mixture of water, oil and mucus, with different glands producing each component. Any condition which disturbs this mixture will cause the eye to become too dry. Your brain detects this dryness and stimulates your large lacrimal gland (which are not typically very active) to flush out your eye, as if you were crying or got sand in your eye. This scenario is often frustrating for patients as they come with a complaint of tearing but their eye doctor tells them that their eyes are dry.

Most eye doctors are very experienced with diagnosing and treating dry eye syndrome. In some situations, however, the prescribed treatments (including artificial lubricating drops, medicated eye drops, or punctal plugs) do not completely control the tearing. A consultation with an oculoplastic surgeon may be recommended in these scenarios as there may be other factors beyond dry eye syndrome contributing to the tearing. Factors such as eyelid laxity and position may prevent the tears from being pushed into the tear ducts (see eyelid laxity), however inadequate function of the tear drainage apparatus could also be contributing and often can only be addressed with surgery.

TEARING DUE TO INADEQUATE TEAR DRAINAGE

The tear drainage system is a network of tubes that drain tears from the eyes into the nose. Normally, if your eyes are watering, you will also likely have a runny nose. The tear drainage system can be partially or completely blocked anywhere along its course, from its initial openings to its last valve in the nose.

In adults, the blockage can be associated with injury, prior surgery to the area including nasal or sinus surgery, infection, or with chronic sinus disease. However, it is often impossible to determine the primary cause.

Children are most often born with complete blockage of their tear system. It is actually normal for the tear drainage system to be imcompletely open at birth. Typically, it will open on its own over the first weeks to months of life.

When the system is blocked, tears may back up and run down the cheeks. Often there is a gooey discharge and eye irritation. In some cases, an infection can develop within the blocked tear system (dacryocystitis).

Most commonly, Dr. Escaravage will perform a test with saline solution in the office to determine the most likely site of the blockage. Based on the examination and tests results, Dr. Escaravage will recommend the optimal surgery or non-surgical treatment. In most cases of tear system surgery, a flexible, clear silicone stent is left in place to stabilize the healing process for several months. It can be easily removed in the office.