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Surgery to alleviate tearing

Tearing is a very common presenting symptom in our office and can be caused by a variety of
factors. The most common causes are dry eye and blepharitis, which is a chronic inflammation
of the eyelid. Dry eyes are treated with lubricating drops. The single most important treatment
of blepharitis is a daily routine of lid margin hygiene with application of warm compresses and
scrubs with baby shampoo. Other causes of tearing include misdirected eyelashes and inverting
of an eyelid causing eyelashes to rub against the eyeball. These can be corrected by either
plucking or burning eyelashes, or performing surgery on the eyelid to rotate it away from the eye
surface. Another cause of tearing is previous history of stroke or facial paralysis causing poor
blink and inability to fully close the eye. Tears are physically pushed into the tear duct with each
blink and if this mechanism is weakened, tears remain on the surface of the eye causing
discomfort and irritation.

Physiologically, tears flow through the lacrimal system starting at puncta (small holes in the
inner corners of our eyelids, continuing onto canalicula (thin tear ducts), and eventually
emptying in the nose through the nasolacrimal duct. Obstruction along any part of this outflow
tract can cause tearing. Punctal stenosis can be addressed in the office with a simple outpatient
procedure which includes enlarging the holes so tears have an easier time getting into the tear
duct. If canalicular stenosis is present, thin silicone tubes can be placed in the operating room
which dilate canaliculi over a period of few months and then are removed in the office.
Acquired Nasolacrimal duct obstruction, most commonly occurring from age-related changes
inside the intranasal portion of the duct, requires Tear Duct (DCR) surgery in the operating room
under general anesthesia. Congenital Nasolacrimal duct obstruction in neonates or infants is
failure of the nasolacrimal duct to open. Such obstructions may resolve spontaneously within the
first few months of life. In fact, 95% of these children will show resolution within the first year
of life. If it does not resolve, surgery may be necessary. Another cause of nasolacrimal duct
obstruction could be poor reconstruction of the nasolacrimal duct system after trauma to the area.
Cause of trauma could be facial fractures and soft tissue trauma involving the nose and/or the
eyelid.

Tear Duct Surgery

Dacryocystorhinostomy (DCR) surgery, done under general anesthesia, aims to eliminate
constant tearing which is frequently very bothersome to patients. It can be performed through a
small incision in the corner of the eye resulting in an almost invisible scar that is well hidden in
the skin crease. Thin silicone tubes are placed at the end of the case and are kept in for several
months after surgery. They are then removed in the office. After surgery there could be slight
bleeding from the nose for several hours. The area around the eye would be black and blue and
swollen for about a week. Once the tube is removed the eye should stop watering, often times
with signs of dry eye until the eye acclimates to its new environment.

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