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, which are different from the lacrimal gland ducts, become clogged, excessive tearing occurs (watery eyes). Abnormal tearing occurs because of blockages in one of three areas:
- Blockage of the tear drain in the nose (nasolacrimal duct obstruction)
- Blockage of the tear drain in the eyelid (canalicular obstruction)
- Blockage of the tear drain opening on the eyelid margin (punctal stenosis)
Treatment for tear duct obstruction
Tearing is fairly common and can be caused by conditions, such as allergy or medication, that only temporally lead to tear duct blockage.
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 and is painless.
- 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.