Tears are a vital element of a stable and healthy ocular surface, which is necessary for preserving visual function intact. After lubricating the eye, tears drain through an intricate drainage system that connects the eye to the nose. This tear duct system begins in the eyelids, which pump the tears through tiny conduits called canaliculi with each blink. The canaliculi transport tears to a reservoir on the inner angle of the eye called the lacrimal sac. Lastly, tears travel through a narrow duct to the nose.
Numerous pathologic conditions may affect this system, with tear duct obstruction and infection most common. Obstruction of the tear duct may occur in the upper part of the duct, the canaliculus, or the lower part of the system where the tear sac or nasolacrimal duct is located.
Surgical repair of the canaliculus
Obstruction of the proximal tear duct may occur from eyelid trauma, chronic use of eye drops, or bacterial infections. Laceration of the canaliculus after facial trauma is one of the main indications for urgent surgical repair of the tear duct. If the surgeon does not intervene promptly, the tissue will scar, resulting in a chronic, teary eye.
Chronic use of glaucoma medications is another cause of tear duct scarring. In such cases, the oculoplastic surgeon can place a silicone stent in the affected canaliculus for 3 to 6 months to restore the system’s function.
Infections of the canaliculus are infrequent but usually require surgery when present. Acute canaliculitis is the term applied to an infection of the canaliculus caused by a retained foreign body or bacterial infection. The best treatment for this condition is surgical drainage of the infected material.
Surgery of the nasolacrimal duct
Most tear duct obstructions occur in the lower part of the system, the lacrimal sac or nasolacrimal duct. These are more common in older females, though younger patients and men are also affected. Symptoms include tearing, mattering, and mucous secretion through the affected eye. In severe cases, an abscess may form in the tear sac.
A DCR (dacryocystorhinostomy) is the procedure of choice to treat obstructions of the nasolacrimal duct. Preferably, the surgery is done through the nose to avoid a scar on the skin. This operation requires general anesthesia, and it is an outpatient procedure, which means that the patient can recover at home.
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