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When tear ducts are blocked, a procedure called Dacryocystorhinostomy (DCR) is necessary to remove the blockage and relieve symptoms associated with dry eye and excessive tearing. Our doctors at Orbit Eye Centre will be able to assess your situation and make any recommendations accordingly.
Tears drain from the eye through a pair of tear ducts at the inner aspects of both upper and lower eyelids. When a person blinks, the tears are pushed into the two openings, into a common duct, and then into a larger duct or area called the lacrimal sac. The sac narrows at its lower end to become the tear duct. The tear duct itself drains into the nasal cavity which is why your nose will run if you cry a lot.
When a duct becomes blocked your eyes will tear a lot because the duct may be infected, and you may experience a discharge from your eye(s).
Reasons Why Tear Ducts Are Blocked:
Many times, tear ducts become blocked for no apparent reason. It is important to mention that while a blocked tear duct will cause tearing, other factors can cause chronic tearing. These will also be investigated and discussed at your initial visit. In some cases, proceeding with surgery will not stop tearing completely if it is partly caused by other factors.
When tear ducts in one or both of your eyes are blocked, our surgeons will perform lacrimal or tear duct surgery (DCR) to reconnect the drainage pathways inside of your nose. Depending on the level at which your tearing system is blocked, we may use an external approach and make a small incision midway between the inner edge of the eye and the bridge of your nose or do endoscopic surgery through the nose. If it is possible to do the procedure endoscopically, this avoids having a tiny external scar. When your surgeon creates a new duct for drainage, they may insert a tiny tube (stent) to prevent the pathway from scaring shut and leave that in place for several months. Such tubes are easily removed during a follow up office visit.
DCR surgery is done in the hospital under a general anesthetic. The procedure takes about an hour to complete on both sides.
Not everyone needs immediate surgery for a blocked tear duct. We may recommend hot packs, antibiotic drops or pills, and massage at the corner of the eye where the tear duct system starts. In addition, you may benefit from the dilation of the duct to relieve the partial obstruction.
However, if less-aggressive measures fail to relieve chronic tenderness and swelling, eye irritation, and mucous discharge, you may need lacrimal surgery.
The exact nature of your DCR surgery will depend on just why the tear duct is blocked. In this regard, you may require extra tests in addition to the examination. These may include either a CT scan or an MRI scan of your nasal passages.
Although you will generally have this surgery performed when you are asleep under general anesthesia, we may suggest doing it with a local anesthetic. In either case, you will not feel any pain.
If the surgery is done by making a small external incision next to the eye and beside your nose, a hole is made in the underlying bone for a new passage between your nose and the lacrimal sac. Here is where you may have a tube (stent) placed to make certain that the passage stays open as it heals. The incision is closed with tiny sutures that are removed in the office on a follow up visit.
If the surgery is done usingan endoscope, there will be no external incision and no stitches to remove.
Make sure to wash your hands before touching your stitches. You will be given an ointment to put on the stitches to keep them moist. The area will look bruised for a couple of weeks and you may experience a tiny amount of bleeding.
You can reduce swelling around the surgical site by sleeping with your head raised using extra pillows at night and by sitting up during the day. Your doctor will advise you to use icepacks around your eyes, nose, and forehead a few times every day for the first few days after your surgery. Do this until any swelling is gone. Wrap the ice pack in a thin towel to prevent the skin from freezing.
You may notice that when you blow your nose after the surgery that air comes up through the duct. This is telling you that the duct is wide open and working well.
Avoid straining and blowing your nose forcefully for two weeks after your surgery as these activities could lead to increased pressure inside the nose and bring on bleeding. If you feel a sneeze coming on, open your mouth as you sneeze to reduce pressure inside the nose. And, in the first days after your surgery do not lift anything heavier than 10 pounds (4.5 kg). When you come back to the office for a follow up visit, you can ask your doctor when it will be OK to resume your normal routine of aerobic, jogging, or other sports activities.
Although you may bathe after your surgery, be certain to not get water, soap, or shampoo around your eyes or nose.
As a rule, you can take acetaminophen (Tylenol) for any pain or discomfort.You should be able to resume any medications that you normally take. Be certain to avoid taking aspirin or medications containing aspirin for at least the first week after surgery. Always bring your meds with you to each appointment so they can be updated before you see the doctor.
While a few drops of blood coming out of your nose for a few days after your surgery should not worry you, your surgeon may tape a “moustache” dressing under your nose and suggest that you lie down, press on the wound area, and use an ice pack. For anything more than a few drops of blood that does not respond promptly to these measures, call the office immediately.
You will have a follow up visit scheduled for you a week after your surgery.
Dr. Karim Punja, an Ophthalmologist at the Calgary Orbit Eye Centre, specializes in oculoplastic surgery and cosmetic and reconstructive eyelid surgery. He has extensive experience in blepharoplasty (droopy eyelids), Botox & fillers, lacrimal & orbital surgery, and cataract surgery.
Dr. Chirag Shah is a comprehensive Ophthalmologist in Calgary and retinal medical specialist. His practice areas focus on retinal diseases, including age-related macular degeneration (AMD), retinal detachments, retinopathy of prematurity (blinding retinal disease in premature babies), diabetic retinopathy, hereditary eye diseases, and hypertensive retinopathy.
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