Tear Duct Surgeries
What Causes Tearing?
Tears are crucial to lubricate the eye and protect it from harmful debris. An excess of tearing can be due to dry, irritated eyes, excess production of tears, or a problem in the tear drainage system. Tears normally drain through small holes in the medial portion of the eyelids called puncta. They then pass through the canalicular system, into the lacrimal sac, and through the nasolacrimal duct into the nose. When the nasolacrimal duct is blocked, tears will overflow out of the eyelids and down the face as if you are crying. The collection of tears in the lacrimal sac can lead to the development of a mucous discharge and can lead to painful infections.
Diagram of Lacrimal System
How is Tearing Treated?
Dr. Hellman will evaluate you for excessive tearing by injecting saline into the tear ducts. If the problem is in the early part of the tear drainage system, he may recommend opening up the punctum and canaliculus surgically to allow better drainage. More commonly the problem is in the nasolacrimal duct. In this case Dr. Hellman performs a surgery from inside the nose to create a connection directly from the lacrimal sac to the nose. This is called an endoscopic dacryocystorhinostomy (DCR). A plastic stent will remain in the tear drainage system for 3 months so that the pathway remains open during the healing process.
Plastic stent in the tear drainage system
What is CDCR?
If the entire tear drainage system is blocked, Dr. Hellman may recommend an endoscopic conjunctivodacryocystorhinostomy (CDCR). For this surgery a permanent glass tube will be implanted, forming a direct pathway for your tears to drain into the nose.