Tear Duct Surgery for Adults

The tear system consists of 3 parts, the lacrimal glands that produce the tear fluid, the openings in the eyelids that let the tears flow out of the eye, and the duct system inside the nose where the tears drain . When the tear system is not functioning properly due to an obstruction, excessive tearing occurs, a condition commonly known as watery eyes or epiphora. Unlike children, a blocked tear duct in adults rarely resolves itself with time requiring a tear duct surgery to address the blockade.

Causes

Some of the causes that may cause blockage in the tear duct system include:

• Chronic infection or inflammation.
• Eyelid malposition (ectropion, entropion, eyelid retraction) in which case eyelid surgery may be necessary.
• Age-related: As we get older the tear drainage opening near the inner edge of the eye ]called puncta (shown in the illustration above) can get narrower which leads to blockage.
• Injury or trauma to the lacrimal system.
• Tumor: A tumor in the nose or anywhere along the tear drainage system can cause blockage.
• Excessive use of eye medications. Although rare, long-term use of certain medications, such as eye drops used to treat glaucoma, can lead to a blocked tear duct.

Treatment

Several surgical options to manage blockage are available depending on the patients case:

• Punctoplasty: Narrow puncta can be opened by a relatively simple and painless procedure.
• Stenting: For partially blocked tear ducts, tubes (or stents) can be placed in the tear ducts for a temporary period of time.
• Dacryocystorhinostomy (DCR): In cases where the tear duct is completely blocked and irreparable A DCR is performed by creating a new tear drainage passageway between the tear duct and the nose to allow the tears to drain.
• C-DCR: in rare cases where the patient has canalicular obstruction a rigid plastic stent (called a Jone’s tube) is placed, from the inner corner of the eye into the nose.