Blocked Tear Duct

Tears are made in the lacrimal glands in your upper eyelids. The tears flow into your eyes through tiny tear ducts and help to keep your eyes free things that could irritate them, like dust. Even if you're asleep, tears are still being produced!

These tears drain out of the eye through the upper and lower puncta, which lead into the canaliculi into the lacrimal sac, and then finally into the nasolacrimal duct, which drains into the nose and down the throat.

Sometimes the nasolacrimal duct can become blocked, which will result in a lot of excess tearing. 

What causes the blockage?

•Trauma, such as a broken nose

•Chronic sinusitis

•Congenital conditions

•Nose polyps

What can be done?

When we first see a patient in consultation, we need to ensure that they indeed have a blocked tear duct. We have many options available to help us diagnose the root of the tearing:

  1. Eyelid examination

  2. Tear duct probing and irrigation.

  3. Endonasal scope

  4. Dacryocystogram (DCG) - This is an x-ray of the tear duct with aid of a contrast dye. 

Once a blockage is identified, we can proceed with surgery to correct the issue. This surgery is called a dacryocystorhinostomy (DCR).

Not everyone will have surgery, especially if the symptoms are not that bothersome. 

Sometimes the blockage can cause infections called dacryocystitis. These can be very painful and require a course of antibiotics and a prompt surgery booking.

The surgery

For the dacryocystorhinostomy (DCR), we are bypassing the blockages in the nasolacrimal duct. An incision is made on the side of the nose, around where glasses would sit. The lacrimal sac is located and a new channel is made from the sac into the nose cavity. Temporary tubes are placed in this new channel for 3-4 weeks whilst it is healing. (See photo to the right)

The surgery takes about 25 minutes per side.

A general anaesthetic or a local anaesthetic with intravenous (IV) sedation can be administered. Local anesthetic with IV sedation has significant advantages including less bleeding and quicker recovery times. With the IV sedation you will be aware of things happening, but will be comfortable. You may not remember the surgery very well afterwards. With a general anesthetic you will be unconscious throughout the procedure. General anesthesia does carry some higher risks and slower recovery time.

Most patients will go home the same day as surgery.

The success rate with surgery is about 95%.

DCR surgery may also be performed endoscopically through the nose. The advantage of this approach is no skin incision. The disadvantage is a general anaesthetic is usually needed and the temporary tubes are left in longer. (Approximately three months vs. three weeks)

This approach does come with a slightly lower success rate of about 85%.

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