Nasolacrimal Duct Obstruction
In order for the eye to stay healthy, it must remain moist. The lacrimal gland, a specialized structure located under the outer one-third of the upper eyelid, produces tears for the eyes. Each time you blink, your eyelids spread tears over the surface of the eye and pump tears into ducts in both the upper and lower eyelids. These ducts then drain those tears into your nose. This is why your nose “runs” when you cry.
Tear duct surgery is necessary when a person’s tear duct is obstructed. This can occur after an infection, broken nose, injuries, chronic sinus problems and a variety of other causes. The two main problems that result are:
- Constant tearing of the eyes when tears are not able to flow into the nose as they normally should.
- Infection caused by stagnation of the tears.
In most cases, if the smaller parts of the tear ducts and tear sac have not been damaged, a procedure can be done using the person’s own tear drainage system and anatomy to establish a new drainage point into the nose so that the tears will flow normally again. This procedure is called a dacryocystorhinostomy (DCR). If the tear duct system cannot be used, an artificial tear drain called a Jones tube is used. This tube is a small Pyrex glass tube that is surgically implanted behind the eyelids in the corner of the affected eye. It allows tears to drain out of the eye and into the nose. This procedure is called a conjunctivodacryocystorhinostomy (CDCR).
WHAT TO EXPECT WITH TEAR DUCT SURGERY
- Access to the lacrimal system is obtained through a small incision at the side of the nose.
- Intra nasal and endoscopic
- Access to the lacrimal system is obtained by direct access through the nose.
Surgery is performed on an outpatient basis under general anesthesia. A new opening is made through the bony structure to create a new passageway. In a DCR, a small silicone tube (Crawford tube) is placed in the tear ducts to help them stay open during healing. This tube is left in for 1-3 months depending on the findings at surgery. This tube is easily removed in the office. In a CDCR, the Jones tube is placed through an opening inside the lower eyelid into the nose. It is secured in place with a suture and is intended to be permanent.
Aspirin or products containing aspirin should not be taken for a period of 2 weeks prior to surgery. Post-operatively, cold compresses are used to help keep swelling to a minimum and thereby reduce the
amount of soreness / pain experienced. There is usually only mild to moderate discomfort. Bloody nasal discharge is normal post-operatively and usually subsides with cold compresses applied with mild pressure. If a nosebleed is persistent, please contact your physician.
Residual tearing is also normal during the post-operative phase while the Crawford tube or Jones tube is in place. While the Crawford tube acts to hold the new passageway open while you are healing, it is also acting as an obstruction to your new drainage system. Jones tubes routinely obstruct with mucus or blood during the healing process. This can be cleared with in office irrigation.
If tearing is persistent after the Crawford tube has been removed, an additional lacrimal surgery may be required. Approximately 5% of all patients who undergo DCR or CDCR surgery require an additional lacrimal procedure due to aggressive wound healing that causes the new lacrimal passageway to close as a result of scar tissue formation. In cases where repeat lacrimal surgery is necessary, a special medication called Mitomycin may be used to retard aggressive wound healing.