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Tearing & Treatment of Lacrimal Drainage Disorder

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In order for the eye to function properly, it must be kept well lubricated. Accordingly, there is an extensive system of glands that produce different components of the tears that work together to form a functional tear film. This tear film is crucial to protecting the delicate surface of the eye, keeping the eye comfortable, and maintaining crisp vision. However, if there are too many tears covering the eye, this can cause significant problems. Patients with excess tearing will often notice: blurred vision, constant tears streaming down the face, redness and skin irritation from constant dabbing of tears, and recurrent infections.

What Causes Excessive Tearing?

The exact cause for the excessive tearing can sometimes be difficult to elicit. This problem can occur if there is an overproduction of tears, decreased drainage of tears, or a combination of the two.

Overproduction

Overproduction of tears may be related to several ocular conditions that will signal your tear gland (lacrimal gland), to produce extra tears. Causes include:

  • Dry eyes
  • Allergies
  • Ocular surface irritation
  • Infections
  • Eyelid inflammation (blepharitis)

The aforementioned conditions can be treated with artificial tears, allergy drops, anti-inflammatory drops, antibiotic drops or ointments, and oral medications.

Decreased drainage

Each eyelid has two small openings (puncta), one on the upper lid and one on the lower lid, that lead into a drainage system, which will empty into a sac (lacrimal sac), that ultimately passes through a duct (Nasolacrimal duct), into the nose. Anatomic variations at any point along this passageway can cause excess tearing. In addition to tearing, a blockage along the drainage system can cause recurrent infections. Symptoms of these infections include warmth and redness in the area in between the eye and nose, purulent discharge, and a pink irritated eye.

Blockage of the tear drainage system can be confirmed in the office by performing a small non-invasive test in the office where a salt solution is irrigated though the tear drain. Depending on the results, corrective options can be discussed. Options to improve drainage may be as simple as starting a regimen of steroid drops, but in certain cases, surgery may be the best option.

 

What are the Surgical Options?

Punctoplasty: This is an in office procedure done under local anesthesia where the small openings of the tear drain (puncta), are dilated with a small instrument and snipped open with very fine specialized instruments. Minimal swelling may be encountered afterward, but normal activity can be resumed almost immediately.

Probe and Tube: This is a procedure performed in the operating room under general anesthesia, and takes about 15 minutes. The procedure involves inserting a small, flexible, temporary tube into the tear duct. The tube functions to dilate any narrowed area along the drainage system. The tube stays in place for approximately 3 months and is painlessly removed in the office. While the tube is in place, tearing is still expected but should improve upon removal of the tube. There is no incision or stitches, and as such recovery is fairly simple, and normal activity is resumed the following day. It is useful in cases of partial tear duct obstructions.

Dacryocystorhinostomy (DCR): This a slightly more involved procedure done in the operating room under general anesthesia which takes about 1 hour to perform. An approximately 1 inch external incision is created in the area in between the eye and nose. The tear sac is identified and opened directly into the nose, through a small passage through the nasal bone. This effectively bypasses blockages of the nasolacrimal duct. A temporary tube is placed to keep the passage open. External stitches are removed in 1 week, and patient may expect a very thin scar that in most cases is not evident after several months. This surgery is useful for complete tear duct blockages that result in severe tearing and often times, recurrent infections.

Conjunctivodacryocystorhinostomy (CDCR): This is a variation of the DCR described above. It involves placing a pyrex glass tube (Jones tube) into the corner of the eye socket that empties directly into the nose. It is typically used in patients who had a previous DCR procedure that either didn't resolve the blockage, or over time has closed up again.

After a thorough evaluation with one of our oculoplastic specialists, an appropriate treatment plan can be initiated.

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