Tear Duct Drainage Surgery or Dacryocystorhinostomy (DCR)
Tear duct surgery, or dacryocystorhinostomy (DCR), is a surgical procedure performed by ophthalmolgists to unblock or drain obstructed or infected tear ducts or other portions of the tear (lacrimal) system. A blockage of the tear system can result in excessive tearing, lack of tears, or infection within the drainage system. Tear duct surgery is more commnly seen in pediatric ophthalmology.
How Tear Ducts Become Blocked
Tears are necessary for keeping the eyes healthy and moist. They are produced from a gland under the upper eyelid called the lacrimal gland and drain into tiny holes (lacrimal puncta) in the inner corner where the upper and lower eyelids meet.
As we blink, tears are pumped into the nose through the tear duct (nasolacrimal duct) and are reabsorbed into the body. The nasolacrimal duct can become obstructed preventing normal tear drainage and increasing the risk of eye inflammation and infection.
Common Causes of Tear Duct Blockage
Tear ducts can become obstructed without presenting an obvious reason. The blockage can be partial or total, and can occur anywhere within the tear drainage system.
Common causes of nasolacrimal obstruction include:
- Aging: Over time, the puncta (openings to the tear ducts) can narrow and cause blockage
- Infection: Can cause inflammation and blockage
- Previous surgery or injury: Scarring or bone damage can obstruct tear flow
- Eyelid weakness
- Loose skin cells or dirt particles: Can become lodged in the tear ducts
- Medicated eye drops: Prolonged use of some medicines can result in blockage
- Cancer treatment: Tear ducts can be affected by radiation or chemotherapy treatments
Symptoms of Nasolacrimal Duct Obstruction (Blocked Tear Duct)
Patients may be unaware of symptoms at the onset of nasolacrimal duct obstruction. They may notice that their eyes are watering, but not realize that the overproduction of tears is actually a blocked tear duct. While a blockage may resolve on its own, it can also result in ongoing infections within the lacrimal sac (which collects the tears), eye inflammation, and mucous build-up.
Symptoms of nasolacrimal duct obstruction include:
- Eye redness or swelling
- Blurred vision
- Recurrent infections, such as conjunctivitis (pink-eye)
- Excessive tearing
- Eye discharge or crusting
Diagnosing Nasolacrimal Duct Obstruction (Blocked Tear Duct)
Diagnosing a blocked tear duct will involve discovering where the blockage is located within the lacrimal system. If a blocked tear duct is suspected, your doctor will conduct a tear drainage test to measure if your tears are draining properly. One drop of a harmless dye is placed on the eye’s surface and observed. The amount of the dye that drains off the eye will determine if the duct is blocked.
Other tests that may be used to diagnose a blocked tear duct include:
- Probing and irrigation: A thin tube (probe) is placed into the lacrimal system to determine if the duct is open. A saline solution is then flushed through the nasolacrimal duct to test if tear drainage is normal.
- Imaging tests: X-ray, CT scan, or MRI may be used to track a special dye placed in the tear drainage system and locate any blockage.
Treatment for Nasolacrimal Duct Obstruction (Blocked Tear Duct)
Treating an obstruction in the tear drainage system often requires tear duct surgery, a surgical procedure, to unblock the nasolacrimal duct. This tear drainage surgery is called a dacryocystorhinostomy (DCR). If the tear duct is partially blocked, your doctor may try to open the duct by flushing water through it. If this is unsuccessful or if the duct is completely blocked, tear drainage surgery is typically the most effective treatment.
Types of tear duct surgery include:
- External DCR: A small incision is made on the top side of the nose near the bridge. The doctor removes a tiny piece of bone to allow drainage between the lacrimal sac and the nose. In some cases, a temporary tube is inserted into the opening to prevent scarring and to keep the duct open. The opening is closed with sutures and the tube is removed about 8 weeks later.
- Endoscopic or endonasal DCR: Tear drainage surgery performed through the nose utilizing an endoscope, a small tube with a tiny camera and light attached. The endoscopic procedure is performed similarly to external DCR without the skin incision.
- Artificial tear duct implantation: Surgical procedure in which a glass-like tube (Jones tube) is implanted behind the eyelid to facilitate tear drainage. These permanent artificial tear ducts are generally used when the nasolacrimal duct cannot be opened or repaired.
Dacryocystorhinostomy is typically performed as an outpatient procedure under general anesthesia.
Post-Operative Care for Dacryocystorhinostomy (Tear Duct Drainage Surgery)
After tear drainage surgery, you may experience some bloody nasal discharge for several days. Refrain from blowing your nose for at least five days after surgery. Your doctor will recommend a nasal decongestant spray, antibiotic ointment for the incision site, and eye drops to prevent infection and inflammation.
Additional tips for recovery from DCR include:
- Keep the incision site clean
- Avoid activities which may allow dirt to enter the wound
- Use ice packs (4 times per day for 2 days) to reduce swelling
- Refrain from strenuous activities
- Use a humidifier to keep air moist
- Use saline nose drops or Afrin to clear nostril mucous
- Do not swim for 2 weeks after surgery
- Clean the wound with a Q-tip and peroxide if necessary
Your doctor will remove the sutures about one week after your tear drainage surgery. Any scarring generally takes a few months to smooth out. If you experience excessive nose bleeding, fever, or your wound is red and tender, contact our office as soon as possible.
If you have symptoms of a blocked tear duct or are interested in being evaluated for a blepharoplasty, please schedule an appointment.
If you would like to learn more about tear duct surgery for nasolacrimal duct obstruction (blocked tear ducts), please call our Fort Worth office at 817-732-5593.