Tear duct surgery refers to a surgical procedure on the tear duct system of the eyes. Blockages or adhesions (lacrimal duct stenosis) mean that tear fluid cannot drain away. This causes the eyes to water constantly and can lead to further infections.
Here you will find further information as well as selected specialists and centers for lacrimal duct surgery.
The lacrimal gland in the eye constantly produces tear fluid. This fluid is necessary to
Excess fluid normally collects on the lower eyelid. From there, it drains via the tear ducts to the nose.
The tear duct begins at the so-called "lacrimal points". These are two small openings in the upper and lower eyelid. The fluid passes through these openings into a smallcanal (" lacrimalcanaliculus "). The canal opens into the lacrimal sac between the inner corner of the eye and the nose. The lacrimal sac then leads into the nasolacrimal duct. This runs through the bony structures around the nose.
The tear fluid finally reaches the nasal cavity.
Anatomy of the human lacrimal system © Erin Silversmith | Wikimedia / License: CC BY-SA 2.5
Blinking with the eyelids distributes tear fluid evenly over the front of the eye. This keeps them moist and healthy. At the same time, the eyelids push fluid into the tear ducts through which it enters the tear duct.
If the tear ducts are blocked or narrowed (tear duct stenosis), the fluid cannot drain away. As a result, it can only spill over the eyelids. Those affected look as if they are constantly crying.
In addition, vision is impaired. Patients have the impression of "looking through an aquarium". This is particularly noticeable when reading.
Tears that remain permanently in the lacrimal sac can also lead to the development of a secondary infection.
The most common symptom of a malfunction of the lacrimal duct is excessive tear formation. This can be caused by
be accompanied.
A more detailed examination reveals the location of the narrowing and its cause. This narrowing usually has to be removed by surgery.
If a malfunction of the tear duct remains untreated, an infection can develop as a result. This in turn sometimes leads to
In the case of an abscess or cellulitis, topical and systemic antibiotic treatment is necessary. This will clear up the infection.
As soon as this is achieved, lacrimal duct surgery is necessary. Its aim is to
All other cases of tear duct dysfunction also require lacrimal duct surgery.
The surgical method depends on the exact diagnosis.
All lacrimal duct operations are performed under general anesthesia. Tear duct surgery can be performed either externally using a Toti operation or minimally invasive endoscopically.
Toti surgery is necessary in the case of a prolonged narrowing of the tear duct between the lacrimal sac and the nose. The operation is also known as a dacryocystorhinostomy (DCR). In this lacrimal duct operation, the malfunction of the lacrimal duct is surgically bypassed. The surgeon creates a new route to the nose through which the tear fluid is drained.
This lacrimal duct operation is performed
performed.
For an endoscopic DCR, the surgeon must be proficient in nasal endoscopy. It is sometimes necessary to correct anomalies of the nasal septum or turbinates. This is the only way to gain access in these cases.
After the procedure, a fine, soft silicone tube is placed for three months. The tube ensures that the surgical bypass remains open and functional during the post-operative healing phase.
If the tear ducts are narrowed but not completely closed, this is referred to as relative tear duct stenosis. In this case, the tear ducts can be probed and widened using balloon dilatation. This means that the tear ducts are mechanically widened again. After the procedure, a silicone tube remains in place for three months as a tear duct splint.
The tubes keep the enlarged tear duct open during the healing phase. This increases the chance that this structure will remain permanently enlarged and functional.
In children with a dysfunction of the tear ducts, the cause is often an incompletely developed nasolacrimal duct. Up to 7 percent of children are affected by this problem. In some children, the tear duct opens spontaneously during the first year of life.
If this does not happen and the symptoms persist, a short lacrimal duct operation is necessary. This involves inserting a fine metal probe through
is pushed.
In severe or repeated cases or in children whose treatment has been delayed, probing is performed in conjunction with silicone intubation. The treatment of lacrimal duct stenosis by probing or silicone intubation has an extremely high success rate.
These lacrimal duct operations are also performed under general anesthesia.
Pain after lacrimal duct surgery is usually minimal and no dressing is required. Patients apply an antibiotic ointment for 7 to 10 days before going to bed.
If a skin incision has been made, it depends on the suture material used whether the stitches need to be removed. This is not necessary if self-absorbing sutures are used.
The silicone tube remains in place for about 3 months. In most cases, it only takes 30 seconds to remove this tube on an outpatient basis with the patient seated in the consultation room.
Bleeding and infections, both potential risks of lacrimal duct surgery, are very rare. Minor bruising and swelling can be expected at the surgical site for one to two weeks.
Occasionally, scar tissue may form later, possibly blocking the newly created tear duct. In this case, a new surgical tear duct operation is advisable.
Most patients experience less tear formation after the operation. Pain after the operation is very mild, if it occurs at all.
Lacrimal duct surgery is a sub-discipline of ophthalmology. It focuses on diseases of the eyelids and the tear duct.
In the 1970s and 1980s, most diseases of the eyelid and lacrimal gland were the responsibility of general ophthalmologists. Today, the circumstances are a little different. Diseases of the eyelid and lacrimal gland are very common. Minor disorders form a significant part of the workload of general ophthalmology.
Sometimes eyelid and lacrimal gland disorders can be treated without surgery. If these measures are ineffective, they are increasingly treated by experts in lacrimal duct surgery.
Tear duct surgery remains part of the training curriculum for ophthalmology specialists. General ophthalmologists generally perform less complex operations, such as corrections of entropion and ectropion.
Ophthalmologists specializing in lacrimal duct surgery have often completed additional training. In some cases, they work exclusively in this sub-discipline.
The surgical repertoire of the lacrimal duct surgeon includes
Lacrimal duct surgeons are also used for
often consulted.
Some lacrimal duct surgeons also perform aesthetic or cosmetic surgery. They work on the eyelids and the periocular tissue, i.e. the tissue around the eye. Possible procedures include
These surgical procedures do not normally fall within the scope of treatment of an ENT specialist. Many of the techniques used in aesthetic surgery are similar to those used in lacrimal duct surgery.
Lacrimal duct surgeons often work closely with experts in related disciplines such as
However, lacrimal duct surgery belongs strictly in the hands of the oculoplastic surgeon, i.e. the ophthalmologist. He is and remains the primary contact for the treatment of watery eyes.
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