Tears are essential for good eyesight, as they nourish, clean, protect and moisturize the eye. They are continuously secreted by the lacrimal glands. Tears are eliminated by blinking and evaporation (wind, heat), or they flow into the nose through the lacrimal ducts.
Tear duct problems can be present from birth, or appear following illness or trauma. They are caused by a blockage or opening in the tear drainage system, for a variety of reasons: infection, trauma, aging, tumor, etc.
Tear duct problems need to be treated promptly. They can lead to complications, some of them very serious, such as meningitis or loss of vision.
What are the symptoms?
- Profuse tearing: this is the most common sign;
- It is aggravated by contact with cold, wind or sun, and after a cold or sinusitis;
- Secretions (“dirty” eyes) or pus in the eyes;
- Swelling, redness, sensitivity and warmth at the edge of or around the eye and nose;
- Repeated and regular eye infections;
- Slightly blurred view ;
- Blood-tinged tears;
- Fever.
How is the diagnosis made?
After routine tests, your ophthalmologist will carry out examinations to detect abnormal tear production.
He/she then observes your eyes, eyelids and nose with a slit lamp (a kind of microscope) to locate any infection or abnormality of the tear ducts.
In case of infection, he/she takes a sample of pus for analysis. To check for any blockage, your ophthalmologist injects a salty liquid through the lacrimal points. He/she may also insert a probe, under local anaesthetic, to check whether there is any resistance in its path. A CT scan can then be used to pinpoint the exact location of the blockage.
If trauma or tumor is suspected, imaging may be performed.
Surgical treatments
Different procedures are available, depending on the nature of the problem and its location in the tear ducts. Your ophthalmologist will explain the procedure that’s right for you.
Surgical treatments are indicated for :
- remove a tumor or foreign body blocking the lacrimal duct
- reconstruct damaged parts and restore the tear drainage system following trauma, infection, burns or facial paralysis.
Inpatient surgical procedures
By lacrimal intubation
This technique is used in cases of partial or total narrowing or repeated inflammation of the canaliculi. The procedure involves the insertion of small silicone tubes
(probes) into the canaliculi to keep them open and empty. The tubes exit through the lacrimonasal sac and canal into the nose. Depending on the case, one or both canaliculi are intubated.
The procedure is performed under general anesthesia.
Endonasal DCR
By dacryocystorhinostomy (DCR)
The procedure involves opening a direct pathway between the lacrimal sac and the nasal cavity, allowing tears and pus to drain directly into the nose. A piece of bone is removed between the lacrimal sac and the nasal cavity. The lacrimal sac is sewn directly to the inner wall of the nose.
The procedure is performed externally or endonasally (through the nose). It is performed under general anesthesia.
By lacorhinostomy
This operation is performed when the tear ducts are partially destroyed, after certain facial paralyses, or when other procedures are not possible. It enables tears to be diverted directly and permanently from the eye to the inside of the nose, without passing through the normal lacrimal ducts. The surgeon makes an incision in the small triangle of skin at the corner of the eye, and places a glass or silicone tube that communicates directly with the nasal cavity.
The procedure is performed under local or general anesthesia.