Lacrimal Surgery

Disease of the tear drainage system can result in excess tear build up in the eye, leading to eyes that are constantly watering and irritated. Additionally, tear duct blockages may lead to painful recurrent infections requiring treatment with antibiotic drops and pills. This can negatively impact vision and quality of life.

A common cause of excess tearing is a blockage of the nasolacrimal duct through which tears flow from the lacrimal sac into the nasal cavity. Such a blockage disrupts the normal flow of tears from the lacrimal gland above the eye, across the eyes, into the lacrimal sac, and then into the nose. Occasionally, the blockage may be relieved by careful probing of the duct and with a stent placed to hold the newly dilated passage open.

In cases of complete obstruction, a dacryocystorhinostomy (DCR) may be necessary. DCR is a surgical procedure that involves creating a new route for the tears to flow from the lacrimal sac directly into the nasal cavity, bypassing the blocked nasolacrimal duct.

Lacrimal Surgery Process

DCR is a same-day outpatient surgery performed through either a small incision made on the side of the nose or endoscopically through cameras inserted into the nose. An opening is made in the bone between the lacrimal sac and the nasal cavity, which creates a direct opening between them and allows tears to bypass the obstructed nasolacrimal duct and resume normal tear flow. Often, a clear plastic tube called a stent is left in to keep the new passageway open. Typically, this tube is removed in about two to three months via a quick in-office procedure.

Are There Any Risks with Lacrimal Surgery?

All surgical procedures have risks. The risks will differ based on age, overall health, the reason for the surgery, and the type of surgery performed. Some possible risks include:

• Excessive bleeding
• Infection
• Facial scar
• Dislodging of the stent
• Nasal congestion or nosebleeds
• Recurrent tearing

Your surgeon will discuss with you the risks in your particular case.

Preparing for Lacrimal Surgery

Your surgeon will discuss with you how best to prepare for your DCR. Prior to surgery, you may have a CT scan or MRI to provide your surgeon with detailed imagery of the nasolacrimal area. Be sure to follow your surgeon’s instructions regarding the taking of medications, and about eating or drinking, in the hours leading up to surgery.

Recovery Time

Your surgeon will let you know what to expect in regards to recovery, which may differ depending on whether an external incision was made or endoscopic cameras were employed. The surgical area may be sore with some bruising, but over-the-counter pain relievers should suffice. Your surgeon may recommend antibiotic ointment and certain medicated eye drops as well. Patients undergoing endoscopic surgery may resume showering immediately with a reduced risk of visible bruising or swelling. Some patients undergoing endoscopic surgery may be able to return to work the following day.

You will likely have a follow-up appointment seven to 10 days after surgery and additional follow-up appointments as determined by your surgeon. Any skin sutures that have been placed are typically removed after a week. Some post-operative care can be coordinated via telemedicine, depending on your specific circumstances. Patients should be careful to avoid blowing their nose for a week after the procedure and should also avoid any strenuous activity during this time.

The scar where the external incision is made will gradually fade over time after the surgery and will be barely perceptible. If you have a stent, it will likely be removed a few months after surgery.