The question of whether one can have their tear ducts removed touches upon a misunderstanding of this delicate biological system, which is formally known as the lacrimal drainage apparatus. Complete, literal removal of the entire tear drainage system is almost never performed because it would cause severe and permanent tearing, a condition called epiphora. Medical interventions focus instead on repairing blockages or creating a bypass to restore the natural flow of tears into the nasal cavity. The goal of any surgery involving the tear ducts is to maintain or improve the function of tear drainage, not to eliminate it entirely.
Function and Anatomy of the Lacrimal Drainage System
The purpose of the lacrimal system is to produce tears that lubricate the eye and then drain away the excess fluid. Tears originate primarily from the lacrimal gland, which is situated above the outer corner of the eye. With every blink, this fluid is spread across the eye’s surface, helping to keep it clean and moist.
Tears are collected by two tiny openings, called the puncta, located on the inner edge of the upper and lower eyelids. These puncta lead into small tubes, the canaliculi, which merge into the lacrimal sac. The lacrimal sac connects to the nasolacrimal duct. This duct channels the tears into the nasal cavity, which is why excessive tearing often causes a runny nose.
Surgical Alteration Versus Complete Removal
The idea of removing the tear duct system is medically unsound because the eye would constantly overflow with tears, leading to blurred vision, skin irritation, and chronic discomfort. Surgeons therefore focus on rerouting or repairing the drainage system rather than destroying it.
The most common intervention for a blocked tear duct is a procedure called dacryocystorhinostomy, or DCR. This surgery does not remove the duct but instead creates an entirely new pathway for tears to travel from the lacrimal sac directly into the nasal cavity. By bypassing the obstructed section of the nasolacrimal duct, the body retains its ability to drain excess fluid.
The DCR procedure drills a small opening through the bone separating the lacrimal sac from the nose, creating a shortcut. This surgical alteration ensures that the tear fluid, which is constantly produced by the lacrimal gland, can find a clear path to the nose. This bypass preserves the eye’s natural lubrication and debris-clearing mechanism without causing permanent epiphora.
Medical Conditions Requiring Intervention
Surgical intervention becomes necessary when the natural tear drainage pathway is blocked, a condition known as nasolacrimal duct obstruction (NLDO). This blockage prevents tears from draining, causing them to pool on the eye’s surface and spill over onto the cheek. The chronic stagnation of tears in the lacrimal sac can create an environment ripe for bacterial growth.
When the lacrimal sac becomes infected, the condition is called dacryocystitis, which manifests as a painful, red swelling near the inner corner of the eye. Other factors that can necessitate surgery include punctal stenosis, where the tiny puncta openings narrow due to age or inflammation, and trauma to the face that damages the bony structure surrounding the duct. Chronic infections and excessive tearing that do not respond to conservative treatments signal the need for surgical correction.
Procedural Details and Long-Term Outcomes
Dacryocystorhinostomy (DCR) is performed using one of two approaches: external or endoscopic. The external DCR involves making a small incision on the side of the nose, near the inner corner of the eye, to access the lacrimal sac and create the new drainage opening. The endoscopic DCR is a less invasive technique performed entirely through the nostrils using a small camera, which avoids an external skin incision.
During both procedures, a small, flexible silicone tube, known as a stent, is temporarily placed to ensure the newly created passage remains open as the tissues heal. This tube stays in place for a few weeks to several months and is then easily removed in a follow-up office visit. Patients can expect minor bruising and swelling, which resolves within a couple of weeks after the surgery.
Long-term outcomes for DCR are excellent, with success rates for external DCR over 90 percent in resolving excessive tearing. Patients are advised to avoid activities like blowing their nose or strenuous exercise for about a week post-surgery. The prognosis involves the successful restoration of normal tear drainage, eliminating chronic watering and reducing the risk of recurring infections.