Lacrimal duct surgery

Disease of the lacrimal ducts

A constantly watery eye or recurring inflammation in the inner corner of the eye with accumulations of secretions can be an indication of a narrowing or blockage of the lacrimal drainage ducts. Several surgical procedures are available to eliminate this.

The "watery eye" in wetting disorders (the so-called "dry eye syndrome") must be distinguished from these inflammations. This is more a qualitative disorder of the tear film. The formation of increased watery tear fluid attempts to minimize friction on the surface of the eye.

Tear ducts

The eye continuously produces tear fluid to protect its surface from drying out and to flush out foreign bodies and pathogens. The three components are mucus, water and an oily secretion. The tear fluid is collected in the inner corner of the eyelid and drains from the upper and lower eyelid via two tiny openings on the nasal edge of the eyelid.

These so-called lacrimal puncta each open into a tear duct, which is surrounded by a fine muscle. With the help of this "active tear pump", the fluid is pumped via the two "tear ducts" into the so-called "lacrimal sac", which is located in a bony dimple on the lateral nasal wall. From here, the tears enter the nose via the so-called nasolacrimal duct through the upper jaw.

Narrowing (stenosis) of the tear duct

If the tear duct is narrowed or blocked, the tear fluid cannot drain away. The eye "overflows" and there is a constant dribbling of tears, known as "epiphora".  The stagnant fluid in the lacrimal tubules and the accumulated tear lake often lead to an increase in bacteria. Apart from the annoying impairment of a constantly watery eye, there is a risk of recurring infections and even severe inflammation.

Visible symptoms of such a so-called "dacryocystitis" are swelling and redness in the inner corner of the eyelid as well as the secretion of a purulent secretion.

Causes

Tear duct constrictions (so-called stenoses) can be congenital or acquired. They are often preceded by an inflammation of the tear duct or an injury. Sometimes, however, ventilation disorders, for example due to polyps in the nose, chronic rhinitis or a curvature of the nasal septum (so-called deviated septum) can lead to an obstruction of the tear duct and to drainage disorders.

Examinations

One of the most important measures is to flush the tear duct with and without dye. This checks its patency. Sometimes a slight blockage can be loosened with so-called lacrimal duct irrigation or probing.

An experienced ophthalmologist can determine the narrowing of the tear ducts in this way. Imaging procedures such as ultrasound, X-ray, computer tomography (CT) or magnetic resonance imaging are even more precise (but also more expensive). Tear duct endoscopy allows all changes in the tear duct to be viewed directly from the inside.

Therapy

Several surgical methods are available to remove stenoses in the tear duct, depending on the cause and location of the narrowing: Accordingly, the obstructions are either removed from the inside using lacrimal duct endoscopy in a minimally invasive procedure, new outflow pathways are created usingDacryocysthorinosomy in an open operation or constrictions in the lacrimal ducts are widened using canalicoplasty.

Fifteen years ago, invasive surgery was required to create a new outflow to the nose when the tear ducts were permanently blocked. However, for several years, patients can be treated gently using miniaturized endoscopes and silicone tube inserts to create a minimally invasive new drain to the nose. This procedure has proven to be very effective. Only 4 percent of patients did not experience any changes after surgery.