What is the Tear Duct?
The tear duct (nasolacrimal duct) is a passageway that drains tears from the eyes into the nose. When there is a narrowing or blockage of the tear duct, your eyes may water or actually drip tears down your cheek. You may also notice excess mucus or crusting in the eyes. In certain cases of severe blockage, you may develop an infection located between the inner corner of the eye and the nose.
Is all tearing and watering of the eyes due to a blocked tear duct?
While a blocked tear duct can certainly cause tearing, there are other potential causes of tearing including:
- Dry eyes
- Corneal diseases
- Eye surgery
- Eyelid malpositions (e.g. ectropion or entropion)
- Lashes touching the surface of the eye (trichiasis)
- Eyelid lesions
- Other causes
Tearing can also be due to a combination of 2 or more causes.
How can I find out if my tearing is due to a nasolacrimal duct problem?
Tearing caused by a nasolacrimal duct blockage normally results in tears running down the face. An oculoplastic surgeon like Dr. Lee can check your tear ducts by irrigating water through the tear duct. This procedure is easily performed in the clinic and is typically painless. Based on how much water irrigates into the nose, we can determine if a tear duct obstruction is present and how severe it is.
How can I develop a blocked tear duct?
There are various ways in which people can develop a blocked tear duct. Normally, it is caused by mild inflammation in the eye, tears, and/or tear ducts. Causes can include:
- Infections in the eye (conjunctivitis)
- Glaucoma medications
- Chemotherapy eye drops (for cancers of the eye)
- Certain types of chemotherapy for breast cancer like tamoxifen (secreted in the tears)
- Radioactive iodine treatment (also secreted in the tears)
- Chemical burns to the eye
- Tumors of the lacrimal drainage system
- Inflammatory conditions of the sinuses
- Facial fractures due to trauma
- Eyelid lacerations that damage the tear drainage system
However, in many cases, patients may have none of the above and still can develop a blocked tear duct. This is due to mild inflammation in the tears and tear film and is more common in people who work in dusty, outdoor environments.
How do you treat a narrow or blocked tear duct?
If there is only mild narrowing of the tear duct, Dr. Lee can place a silicone stent down the tear duct to help dilate the passageway. This procedure is performed either in the clinic with local anesthetic, or in a surgery center with IV sedation. It takes about 5 minutes to perform, there is minimal pain after surgery, and there are no restrictions on activity. The stent is usually left in place for several weeks and can be removed easily in the clinic.
If there is a significant or complete blockage of the tear duct, this can be fixed with a tear duct surgery (aka DCR surgery). This surgery is performed in a surgery center or hospital with either IV sedation or general anesthesia. Dr. Lee creates a new tear drainage passageway that routes the tears away from the blockage and into the nose. The surgery takes about 1 hour and can be done completely from inside the nose with no scars or skin incisions (endoscopic DCR). Alternatively, it can be done through a small skin incision on the side of the nose (external DCR). At the end of the surgery, a silicone stent is placed and later removed after 2-3 months. The stent helps prevent scarring and closure of the new passageway while everything heals. Patients go home the same day and have minimal pain after surgery.
Which is better—an endoscopic DCR or an external DCR?
Dr. Lee prefers the endoscopic DCR because there are no skin incisions or scars, there is a faster recovery time, and it can be performed even if there is an active tear duct infection. This is a more modern surgical approach,
However, if patients are very sick, have unusual anatomy, or cannot stop their blood thinners prior to surgery, an external DCR can still be a successful operation. The scar typically heals well and is barely visible after several months, especially in older patients.
What is the “down time” after Tear Duct Surgery?
After an endoscopic DCR, recovery is quick. Patients may have some mild bruising and swelling but this is usually minimal. There may be some mild blood-tinged drainage from the nose for the first 1-2 days. There is typically almost no pain. Tearing often improves as early as the first week.
There is minimal pain after surgery. Patients can walk around the same day of surgery and do light activities, including using the computer or watching TV. They should avoid heavy lifting, straining, or bending for the first 2 weeks. Antibiotic drops for the eye and a steroid nasal spray (Flonase) is used for the first two weeks. Patients should also do nasal saline sprays several times per day for the first few weeks to help keep the nasal passageways clean and free from clots/crusting. This helps you to heal faster and breathe better through your nose. The stent is removed in clinic after 2-3 months.
Are there any problems with choosing not to have tear duct surgery?
If you have a blocked tear duct and are a candidate for tear duct surgery, it is usually not mandatory to have surgery right away. If you choose not to have surgery, you may have persistent tearing, crusting, and infections of the tear duct. However, a blocked tear duct is usually not vision or life-threatening. The tearing is merely annoying.
However, it is a good idea to be evaluated since patients in rare cases may have a blocked tear duct due to a cancer of the tear duct, nose, or sinuses.
If you are planning to have eye surgery (e.g. cataract surgery, glaucoma surgery, etc), your ophthalmologist may want you to have the tear duct surgery prior to your eye surgery. This is because a blocked tear duct can result in increased bacteria in the eye, which can lead to a serious eye infection after eye surgery.
Schedule Your Consultation Today
If you are suffering from tearing, infections, or blockage of the tear duct or need blepharoplasty, schedule your consultation today to get started with Dr. Lee.