Abnormal Tearing Procedures/Surgeries
(including Dry Eye treatment)
What do these procedures help?
The tears are produced by the lacrimal and the eyelid glands and are responsible for protecting and keeping the eye moist. When the ducts responsible for allowing the tears to drain become clogged, excessive tearing occurs (watery eyes).
Tear duct obstruction in infants is usually caused by a thin membrane blocking the opening of the tear duct in the nose and typically resolves itself before the child is one year old. If the problem persists, it may be necessary to open the blocked tear duct surgically. If the child is born with a blockage, the condition is classified as congenital nasolacrimal duct obstruction.
A blocked tear duct in adults rarely resolves itself if not caused by infection, medication or allergy and it may be necessary to have surgery to open the blocked tear duct. Tear duct surgery options include:
Tear duct opening (punctoplasty) – If the punctum (tear duct opening on the eyelid margin) is narrow, a minor, painless procedure can be done in the office under local anesthesia to open it.
Tear duct intubation (stenting) – For narrowed but not completely blocked tear ducts (usually related to medication), tubes (or stents) can be placed in the tear ducts for a couple of months to prevent further or permanent scarring. This procedure can be done either in the office or in the operating room under minor sedation. Tube removal is performed in the office and is painless.
Dacryocystorhinostomy (DCR) – If damage to the tear duct is irreparable, a bypass communication needs to be created between the tear duct and the nose to allow the tears to drain. This procedure, called dacryocystorhinostomy, is performed in the operating room under general anesthesia or deep sedation and also involves placing tubes (or stents) in the lacrimal ducts for a couple of months. Tube removal is performed in the office.
Jones Tube placement (cDCR) – when there are no lacrimal canaliculi left in the eyelids, a rigid plastic tube (the Jones tube) is placed, after a DCR surgery is performed, from the inner corner of the eye into the nose. The tube in this case will stay in place permanently, although occasionally it needs to be replaced.
Dry eye occurs when the eyes aren’t sufficiently moisturized, leading to itching, redness and pain. The eyes may become dry and irritated because the tear ducts don’t produce enough tears, or because the tears themselves have a chemical imbalance.
People usually begin experiencing dry eye symptoms as they age, but the condition can also result from certain medications, conditions or injuries.
Dry eye is not only painful, it can also damage the eye’s tissues and impair vision. Fortunately, many treatment options are available.
Non-surgical treatments for dry eye include blinking exercises, increasing humidity at home or work, and use of artificial tears or moisturizing ointment. If these methods fail, small punctal plugs may be inserted in the corners of the eyes to limit tear drainage, or the drainage tubes in the eyes may be surgically closed. Upper and lower retraction repair is sometimes needed to treat dry eye related exposure. Tarsorraphy (closing of the inner and outer eyelids) may be needed to decrease dry eye related to exposure.