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The tear film on the surface of the eye is a critical component of maintaining vision. Tears nourish and lubricate the surface of the eye as well as wash away debris. A smooth, balanced tear film (consisting of water, oil and mucus) also allows light to enter the eye in an optimal fashion. If there is a disturbance of the tear film, patients will often experience tearing, burning, irritation and most importantly blurred vision. Patients who experience tearing either have a problem with tear production or tear drainage. Tear Duct Surgery may be a solution, but only after attempting easier solutions.

Increased Tear Production and Dry Eyes

The eye has two sets of structures that produce tears. Smaller tear glands help maintain a baseline level of moisture on the surface of the eye. Unfortunately, inflammatory conditions like rheumatoid arthritis, Sjogrens disease as well as aging and menopause lead to decreased tear production. As tear production diminishes, the surface of the eye starts to dry out. Also, inflammation of the oil glands along the edge of the eyelid, common in patients with roseacea, also causes early breakdown and evaporation of the tear film. The brain senses the eye is both dry and irritated and in turn signals the main tear gland to flush the eye. As a result, the dry eye paradoxically tears and becomes watery. Patients with dry eyes note intermittent tearing of the eyes during activities like reading, driving, watching TV, using a computer or going outside on a windy day. These all cause the eye to dry out because the eye blinks less during these activities. The treatment for dry eyes includes 1) replacing tears with artificial lubricants which can be bought over the counter, 2) medications like Restasis that decrease inflammation in tear glands and encourages natural tear production to resume and finally 3) tear duct surgery to plug the tear drain. Other causes of increased tear production exist like allergies, infections and eyelashes poking the eye. These conditions can often be found during examination.

What are the causes that lead to Tear Duct Surgery?

An obstruction of the tear ducts may occur due to numerous reasons (aging, trauma, inflammatory conditions, medications and tumors) and cause numerous signs and symptoms ranging from wateriness or tearing to discharge, swelling, pain and infection. These signs and symptoms may result from the tear drainage system becoming obstructed at any point from the puncta to the nasal cavity.

What are the Symptoms of Obstructed Tear Ducts?

If the tear passageways become blocked, tears cannot drain properly and may overflow from the eyelids onto the face as if you were crying. In addition to excessive tearing you may also experience blurred vision, mucous discharge, eye irritation, and painful swelling in the inner corner of the eyelids. A thorough examination by Dr Pooya can determine the cause of tearing and the recommended treatment which may be as simple as using special eye drops or may require tear duct surgery.

How is an Obstructed Tear Duct Treated or Repaired?

Depending on your symptoms and their severity, Dr Pooya will suggest an appropriate course. In mild cases, a treatment of warm compresses and antibiotics may be recommended. In more severe cases, you may require tear duct surgery to bypass the tear duct obstruction (dacryocystorhinostomy or DCR surgery).

A DCR is performed by creating a new tear passageway from the lacrimal sac to the nose, bypassing the obstruction. A small silicone tube called a stent may temporarily be placed in the new passageway to keep it open during the healing process. In a small percentage of cases, the obstruction is between the puncta and the lacrimal sac. In these cases, in addition to the DCR procedure, the surgeon will insert a tiny artificial tear drain called a Jones Tube. A Jones Tube is made of Pyrex glass and allows tears to drain directly from the eye to the lacrimal sac. Majority of the tear duct surgery procedures Dr Pooya performs are done endoscopically through the nose with no skin incision and therefore no visible scar to the patient.

Tear duct surgery is usually performed as an outpatient procedure. Patients usually have some bruising and swelling on the side of the nose after tear duct surgery that subsides in one to two weeks. In general, surgery has a greater than 90% success rate and most patients experience a resolution of their tearing and discharge problems once surgery and recovery are completed.

If you have experienced this condition, we recommend you schedule an appointment to meet with Dr Pooya for an examination to determine how we can help you alleviate this condition.