Treatments for Epiphora

What is Dacryocystorhinostomy (External and Transcanalicular Laser)?

Dacryocystorhinostomy is a procedure to treat watery and sticky eyes caused by narrowing or blockage of the tear drainage tubes. Tears normally drain from the inner corner of the eye into the tear sac and down into the back of our nose. Any blockage in this channel can cause the tears to overflow causing epiphora/watery eyes. This procedure is indicated when damage to the tear duct is irreparable requiring a bypass between the duct and the nose to address the problem.  During a dacryocystorhinostomy, a new passage is created going around any blockage below the tear sac, between the tear sac and the nose. The same procedure can be modified to treat blockages higher up in the tear drainage system.

Depending on your condition, dacryocystorhinostomy may be performed externally (through the skin) or endoscopically through the nose using transcanalicular laser.

What is External Dacryocystorhinostomy?

During this procedure, a nick is made on the side of your nose to access the tear sac. A small piece of bone is removed from between the tear sac and the nose to get to the inside of the nose. A direct channel is created between the tear sac and the nose by opening the tear sac and stitching it to the lining of the nose. A soft silicon tube is placed in the channel to keep it open while healing occurs. The tube remains hidden and is painlessly removed 6-12 weeks after the procedure.

What is Transcanalicular Laser?

Transcanalicular Laser dacryocystorhinostomy is a minimally invasive endoscopic procedure to treat epiphora. During this procedure, a fiber optic light probe is inserted through the nasal cavity to the lacrimal sac (tear sac). The nasal mucous membrane is excised, and an opening is created on the lacrimal sac and upper nasolacrimal duct (tear duct). A small piece of the lacrimal and maxilla bone is removed, and an incision is made in the lacrimal sac and nasolacrimal duct. A soft silicon tube is placed to keep the tract open until healing occurs. Compared to external dacryocystorhinostomy, the endoscopic approach helps avoid external scar formation, decreases intra-operative time and bleeding, and creates less damage to the lacrimal pump mechanism.

What is Probing & Syringing +/- Intubation?

Probing and syringing are performed to open blocked tear ducts. It can be performed under local or general anesthesia as an outpatient procedure. During this procedure, a thin flexible probe (wire) is inserted down the tear duct to clear any blockage. Once probing is completed, the area is washed out with normal saline using a lacrimal irrigation cannula attached to a syringe. If the tear duct remains blocked, a procedure known as intubation is performed where a temporary silicone tube is implanted to keep the tract open.

What is Lacrimal Stents?

Lacrimal stenting can be performed as an outpatient procedure under moderate sedation.

Lacrimal stents are thin tubes that are implanted in patients with narrowed but not completely blocked tear ducts. They function to keep the tear duct open and help prevent further scarring. They can be placed in the tear duct for a couple of weeks and can be removed in your doctor’s office with a painless procedure. A variety of stents are available for different conditions and your doctor will decide on the best one suitable for your specific condition.