Lacrimal surgery, also known as tear duct surgery, is a surgical procedure that creates a new tear duct between the eye and nose when the duct has become permanently dysfunctional and causes excessive tearing.
Excessive tearing, also known as epiphora, has many causes. The most common cause is dry eyes. When the eye does not make enough tears, the lacrimal gland responds by secreting a watery type of tears which do not stick to the eye. Thus, the eye continues to be dry. This becomes a cycle that can often be broken by using topical lubricants.
Another cause of excess tearing is lacrimal duct obstruction. Normally, tears are made in the eye and drain into the nose through small holes in the nasal portion of the eyelids called the punctum. A blockage anywhere from the punctum to the bony lacrimal canal in the nose can cause the tears to back-up and run down the cheek. Surgery to correct these problems range from dilating the tear duct to bypassing the duct by creating a new pathway into the nose.
An additional cause of tearing in lower eyelid laxity. This can be due to aging or due to prior eyelid surgery. If the lower eyelid sits too low relative to the eye, tears will well-up behind the lid and eventually run down the cheek. Furthermore, tears will evaporate faster because more of the eye is exposed. This allows the eye to dry out, creating the cycle of excess tearing to compensate for a dry eye.
Some causes are congenital, meaning a person was born with a tear duct that just never drained properly due to anatomical issues. Chronic nasal infections, eye infections, nasal polyps, tumor of the eyelids, or trauma can all cause the tear ducts to function poorly or not at all.
In mild cases, surgery can involve opening the tear duct with a small incision at the opening of the tear duct of the eyelid. In moderate cases, a balloon can be used to open the tear duct
In more severe cases, a new boney opening from the tear ducts into the nose must be created, called dacryocystorhinostomy (DCR). This can be performed using a small incision on the side of the nose or endoscopically from inside the nose. This opening will connect the lacrimal sac and your nasal cavity to allow drainage through the tear duct. A small stent may be inserted to keep the duct open for a time.
To resolve issues caused by eyelid laxity, surgery generally involves raising and tightening the lower eyelid. Severe cases require elevating the cheek as well in order to support the lower eyelid.
Recovery from lacrimal surgery will involve plenty of rest, elevation of your head and typically eye drops to help the new duct drain and prevent infection. Nasal cavity rinses may be recommended, and over-the-counter decongestants and nasal steroids may help with any congestion than often develops temporarily after the procedure.
Length of recovery can vary depending on multiple factors including age, health, genetics and previous surgery. It is common for patients to develop bruising and swelling the majority of the swelling goes away in two to three weeks, but some swelling can last for a longer period of time as every patient heals at different rates depending on age and skin type. Dr. Marshak will personally see you frequently in the post-operative period to monitor your healing and ensure you are on course.
Lacrimal surgery under the care of Dr. Marshak can often correct problems of chronic tearing. If you suffer from a dysfunctional tear duct and are interested in learning more about how you can free yourself from the constant bother of excessive tearing or worse, contact Dr. Marshak in Palm Desert today.