The lacrimal system is the body’s drainage network for tears, which lubricate and protect the eye surface. Tears collect in the inner corner of the eye and flow through small channels into the nose via the nasolacrimal duct. Tear duct surgery, medically known as Dacryocystorhinostomy (DCR), is a corrective procedure performed when this drainage pathway becomes blocked or severely narrowed. DCR restores the normal flow of tears by diverting them around the obstruction. This intervention alleviates persistent symptoms caused by compromised tear flow.
Conditions Requiring Intervention
The most common symptom indicating a need for intervention is epiphora, the persistent overflow of tears onto the cheek. Epiphora results from the drainage system failing to keep pace with normal tear production. This constant moisture can lead to skin irritation and blurred vision.
When tears are unable to drain, they become stagnant in the lacrimal sac, creating an environment ripe for bacterial growth. This stagnation often results in dacryocystitis, an infection of the lacrimal sac characterized by painful swelling, redness, and a discharge of mucus or pus.
Blockages are categorized as either congenital or acquired. Congenital obstruction occurs in infants, typically due to an undeveloped membrane at the end of the duct. Acquired blockages in adults are often caused by chronic sinus inflammation, facial trauma, or age-related narrowing. Surgery is reserved for cases that do not respond to conservative management or for chronic infections that risk eye health.
Common Surgical Techniques
The definitive treatment for most adults with an acquired blockage is Dacryocystorhinostomy (DCR), which creates a new drainage route into the nasal cavity, bypassing the obstructed duct. The external DCR involves a small incision on the side of the nose, allowing the surgeon direct visualization of the lacrimal sac and surrounding bone. A small opening is created in the bone separating the lacrimal sac from the nasal cavity, establishing a new, direct connection. Success rates for the external approach are consistently high, often ranging from 85% to 95%.
Alternatively, endonasal DCR is performed entirely through the nostril using an endoscope, avoiding an external skin incision and resulting scar. The surgeon uses specialized instruments to remove the bone and tissue separating the lacrimal sac from the nose, creating a new drainage channel. This minimally invasive method has comparable success rates to the external approach, often falling between 90% and 96%. Both DCR techniques often involve the temporary placement of a thin silicone tube, or stent, which helps to keep the passage patent during the initial healing phase.
For children with congenital blockages, lacrimal probing is typically the first surgical step if the condition does not resolve spontaneously. A fine, flexible metal probe is gently inserted through the tear duct opening to puncture the obstructing membrane. This brief procedure, usually performed under general anesthesia, aims to open the natural pathway without creating a new one. If probing is unsuccessful or the blockage is complex, a silicone stent may be placed before a definitive DCR is considered.
The Post-Operative Process
Immediately following DCR surgery, patients can expect temporary side effects, including bruising and swelling around the eye and nose, which generally subsides within the first week. It is also common to experience a bloody discharge from the nose or the back of the throat for three to five days as the surgical site heals. Discomfort is typically managed with prescribed pain medication, and the use of cold compresses applied to the area can help minimize swelling.
Patient care instructions focus on protecting the newly created drainage pathway. It is important to avoid blowing the nose forcefully for at least the first week, as the pressure can dislodge the stent or cause bleeding at the surgical site. Sneezing should be performed with the mouth open to reduce internal pressure. Patients are usually given a regimen of antibiotic eye drops and, for some DCR procedures, a saline nasal wash to keep the area clean and prevent infection.
If a silicone stent was placed during the DCR, it typically remains in position for two to six months to ensure the new channel has healed open before being removed. Stitches from an external DCR are usually removed about one week after the procedure. Patients are advised to keep their head elevated for the first few days and avoid strenuous activities or heavy lifting for about one to two weeks.