Tears usually drain through small openings in the corners of the eyelids, known as puncta, and enter the nose through the nasolacrimal duct. When an obstruction exists, tears cannot properly drain from the eyes and may well up on the surface of the eye and overflow on the eyelashes and eyelids. The eyelids may also become red and swollen with yellow or green discharge.
If this blockage cannot be effectively treated through conservative methods, surgery will likely be recommended. A procedure known as dacryocystorhynostomy or dacryocystorhinostomy (DCR) will be performed to construct a new tear drain. This type of surgery is usually performed as an outpatient procedure, either using local anesthesia and sedation or general anesthesia.
Causes of a Blocked Tear Duct
A blocked tear duct may be the result of the following conditions:
A blocked tear duct almost always is correctable, but the treatment depends on the cause and your age.
Symptoms of a Blocked Tear Duct
The symptoms of a blocked tear duct may include:
- Excessive tearing
- Discharge from the eyes
- Crusty eyelashes or eyelids
- Blurry vision
- Bloody tears
- An abscess in the inner corner of the eye
The Endoscopic Tear Duct Procedure
No incision is necessary when undergoing an endoscopic DCR. With the traditional form of this surgery, the doctor would make an incision on the side of the nose, which would leave a scar. With the endoscopic approach, the surgeon uses an endoscope-a thin, flexible, lighted tube with a microscopic camera on the end. The camera helps the doctor guide other tiny instruments, used in the procedure, through the nasal opening to access the tear duct area.
A new tear drain opening is then created, providing a fresh route between the eyes and nose avoiding the obstruction. A tiny stent may be placed in the new tear drain and kept there for several months after the procedure ensuring the duct will remain open. In cases in which the tear drain blockage cannot be cleared, a small drain, known as a Jones tube, may need to be inserted in the area. This offers a permanent solution to keeping the tear duct clear.
Advantages of Endoscopic Tear Duct Surgery
A major advantage of having an endoscopic DCR is that no incision is made, meaning no scar will form on the face. It is also a less invasive method of surgery, so the recovery is generally both shorter in duration and more manageable.
After the surgery, there is a standard recovery time of one week. Most patients require a nasal decongestant spray and antibiotic ointment or drops to prevent infection. You may experience bruising or swelling in the eye region, which typically resolves within two weeks.
Endoscopic DCR has a very high success rate and is considered a safe, low-risk procedure. However, all surgical procedures do carry some risk of complications. Those associated with a DCR are typically bleeding, infection and problems stemming from use of anesthesia.