Tearing and Tear Duct Surgery

Excessive tearing or a reduced ability to drain tears can be a very bothersome issue for patients.  There are a number of underlying causes for tearing issues including dry eyes, ocular irritation, abnormalities or loosening of the eyelid tissues, or obstruction of the tear drainage system or tear duct.

The majority of the tears are made in the tear (lacrimal) gland that is located in the upper outer area above the eye.  These tears bathe across the surface of the eyes, are pumped from the outside corner toward the inside corner of the eyelids and are drained by upper and lower tear duct openings located at the edge of the inside corners of the eyelid.  These tears collect in the tear sac located between the eyelids and the nose, and then they drain through a tear (nasolacrimal) duct that empties inside of the nasal cavity.  

To determine the cause of excessive tearing, a thorough history will be obtained.  The tissues of the eyes and eyelids will also be examined for any underlying reasons for the tearing problems.  In most circumstances, irrigation of the tear drainage system is also performed in the office setting to help in determining the extent and location of any tear duct problems.  Obstructions can occur in any portion of the tear drainage system, and the treatment is tailored to the specific location of the blockage.  

If a partial or complete tear duct obstruction is noted on examination, a tear duct surgery is typically recommended.  Most commonly, a dacryocystorhinostomy, or DCR, is performed.  During this outpatient procedure, the tear sac is opened into the nasal cavity in a way to allow the natural tears to bypass the blockage in the tear duct.  This procedure allows a return to the natural flow of the tear system.  This DCR surgery may be performed through a small skin incision located between the eye and the nose, or by utilizing an endoscopic camera system through the nose.  As part of the surgery, a temporary tear duct stent tube is typically placed in the newly created drainage system to help keep the tissues open and flowing during the healing period.