Tear duct blockage refers to the partial or complete obstruction of the eye’s drainage system. When the eye’s drainage system is blocked, it can lead to irritated, watery, or chronically infected eyes. Children may be affected by a congenital blocked tear duct (born with it), while adults may develop a blocked tear duct form a tumor affecting the eye, or eye infection, inflammation, or injury. Surgery is one of the treatments for blocked tear duct and is performed if the condition does not resolve on its own or when other treatment options like a special massage technique do not help. Before considering surgery for a blocked tear duct, it is recommended that the patient waits a few months to see if healing can take place. A dacryocystorhinostomy (DCR) creates a new tear drain between the nose and eye.
Before the Procedure
The patient may be required to stop taking certain medications before surgery. S/he must also avoid eating anything on the eve of the surgery. Tests to get a better view of the anatomy of the nasal passages may be conducted. They include imaging tests like CT scans and MRI.
Before surgery, the patient is given medication to relax or an injection to numb the area and may be awake during the procedure. Packing materials soaked in anesthetics are placed inside the nose so the patient won’t feel anything and to cause less bleeding in the operation. The doctor may put some patients to sleep using anesthesia.
- A DCR is mainly used in adults and rarely in children. Surgeons use different steps for this procedure depending on the particular tear duct blockage. There are two types of DCR, external and endoscopic or endonasal. During the external procedure, the surgeon will make a new opening that extends from the lacrimal sac to the nasal cavity. S/he makes an incision in the area of the skin located below the eye and next to the nose. This enables the opening to be created beneath the bone which then connects the nasal cavity to the lacrimal sac. To help keep the newly opened tear duct open, the surgeon can leave in a small tube or stent. The stent and tube can be removed three to four months following surgery. The incision is closed using stitches. In the second method, small instruments and a microscopic camera are inserted via the nasal opening to the duct system. Although no incisions are used and less pain is caused, the endoscopic has a lower success rate compared to the external procedure.
- A conjunctivodacryocystorhinostomy is a procedure where the entire drainage system is reconstructed. An entirely new route is created from the puncta (the inside corner of the eye) to the nose where the tear drainage system is bypassed altogether.
- For blocked tear ducts caused by tumors, the only treatment required may be the removal of the tumor responsible for the blocked tear duct through surgery or other mechanisms like shrinking the tumor.
Risks & Complications
Possible risks may include:
- Stuffy nose
- Excess bleeding
- Stent displacement
- Bruising around the area
- Scars if external surgery was used
- Tissue in the nose may be abnormally fused
- The DRC may not be effective
Aftercare & Recovery
Antibiotics may be prescribed to prevent infection from developing. Other medications such as steroids and nasal decongestants may also be prescribed to prevent infection and reduce inflammation. Over-the-counter pain medications are prescribed to relieve pain since the site may be a little sore following surgery.
Ice packs can be used on the affected area for approximately two days following the procedure to help control inflammation. The patient can maintain a 45-degree angle for the heat and avoid blowing the nose for a week to prevent excessive bleeding.
The patient is given instructions on how to care for the eyes, nose, and wound which must be followed strictly. Instructions are also issued on how to rinse the nasal cavity. The doctor may provide restrictions on certain activities during the recovery period such as martial arts and soccer. The patient should resume normal activities in one week.
Close follow-up care is required to establish whether the surgery was a success. The first follow-up visit is scheduled the day after the procedure. If non-absorbable sutures were used, they can be removed in about a week. Continuous follow-up is required to monitor progress. If a stent is placed, it is removed three to six months later.
Research indicates that DCRs success rate is 90%.