Lacrimal duct stenosis surgery

We speak of tear duct stenosis when the outflow of the tear fluid towards the nose is blocked. Such an obstruction often occurs in babies, for example. In this case, the development of the tear ducts is not yet complete and the lacrimation usually disappears after some time. In adults, depending on the cause of the watering, spontaneous improvement is also possible. However, if the symptoms persist for a long time and the tear ducts are permanently narrowed or blocked, a tear duct stenosis operation may be necessary. Depending on where the tear ducts are narrowed, different surgical techniques are used.

What is lacrimal duct stenosis?

The term tear duct stenosis refers to an obstruction or narrowing of the tear ducts. These serve as a drain for the tear fluid from the eye to the nose.

The tear fluid is formed above the eye in the lacrimal gland and is distributed from there into the eye via the blink. Its task is to keep the eyes continuously moist and to flush foreign bodies out of the eye. It also has a germicidal effect and supplies the cornea with nutrients. 

From the inner corners of the eyelids, the tear fluid is drained via the tear ducts towards the nose. In the process, it reaches the lacrimal tubules via the so-called lacrimal puncta. These open into the lacrimal sac, from where the tears reach the nose via the nasolacrimal duct. If the tear ducts are blocked or narrowed, there is a constant trickling of tears. As a result, skin irritation and inflammation can also occur. Inflammation of the lacrimal sac in particular can lead to severe pain and a considerable reduction in well-being. Severe lacrimal sac inflammation may require systemic antibiotics and hospitalisation.

What can cause lacrimal duct stenosis?

Tear duct stenosis can be congenital. However, it often develops later in life due to inflammation of the conjunctiva or the lacrimal drainage system. Inflammation of the nose and sinuses can also cause the tear ducts to narrow, making tear duct surgery necessary. In newborns, the obstruction is usually due to the tear ducts being closed by a fine membrane. This usually regresses during the first few months of life. Until then, regular massages, for example, can help open the tear duct.

How can we treat tear duct stenosis?

In our eye clinic we can treat lacrimal duct stenosis with different measures. The aim of a tear duct stenosis operation is always to restore the regular flow of tears. For this purpose, we use e.g. rinsing, probing, dilatation and tear duct splinting. In tear duct splinting, for example, small silicone tubes are gently inserted into the tear ducts with the help of probes. They remain there for a few weeks until the outflow of tears is restored. If the obstruction is more extensive, a so-called dacryocystorhinostomy may also be necessary. Also known as Toti surgery.

In the Toti tear duct operation, a new drain for the tear fluid is created. This runs from the lacrimal sac to the nasal cavity. When deciding on a form of treatment, our doctors always have the causes of your complaints in mind. In particular, the exact location of the constriction must be taken into account.

The primary goal of lacrimal duct surgery is always to permanently eliminate lacrimation in the gentlest possible way and to prevent inflammation.

What is the procedure for lacrimal surgery?

Before a lacrimal duct operation, your ophthalmologist will first carry out comprehensive preliminary examinations. It is important for the doctor to distinguish between an obstruction and a narrowing of the tear ducts. It is also important to find out whether the tear tearing is caused by another disease. If this is not the case, the exact location of the constriction is determined by flushing the tear ducts. The doctor will then plan the tear duct operation together with you. We have several different procedures to choose from for lacrimal surgery. If only tear duct rinsing and probing is to be carried out, the treatment can possibly take place under local anaesthetic. However, a short general anaesthetic is usually necessary for lacrimal surgery.

When probing the tear ducts, the surgeon inserts a fine silicone tube or a special silicone probe into the tear duct. After the tear duct operation, the silicone tube remains in place for about 3 months, preventing the tear duct from becoming blocked again. It is then removed again during a check-up in the consultation. If the tear ducts below the lacrimal sac are completely blocked, the surgeon creates an artificial drain for the tear fluid (so-called Toti operation).

This type of tear duct surgery is always performed under general anaesthesia. The lacrimal sac is exposed through a fine incision between the nose and the lower eyelid. After a small bone window is created, a new drainage channel is created by suturing the mucous membrane of the lacrimal sac to the nasal mucosa. In this procedure, too, the surgeon places fine silicone probes with which the newly created tear ducts are kept open until after healing. The fine incisions are then sutured.

Depending on the extent of the operation, it may be necessary for you to stay overnight as an inpatient at our clinic. In this way, we can offer you the best possible all-round care after your lacrimal surgery.

Your ophthalmologist may prescribe eye drops and/or eye ointment for the time after the tear duct operation. You should use these as prescribed. 

It is also important that you do not blow your nose during the following weeks.

What complications can occur?

As with any operation, complications such as secondary bleeding, infections or wound healing problems are possible. The risk of complications - especially post-operative bleeding - depends very much on the surgical method. It is important for a successful tear duct operation that it is performed by an experienced surgeon.

This is guaranteed in our specialised eye clinic. During the first week after the operation, you should expect the eye area to be swollen and bruised. This is quite normal and no cause for concern. After 14 days at the latest, the visible traces of the tear duct operation should have faded away.

If the silicone tube accidentally slips out of position, this is not dangerous at first. However, you should contact your ophthalmologist immediately. He or she will then decide whether the tube needs to be repositioned or reinserted for further healing. 

Can tear duct stenosis come back?

Recurrence after lacrimal duct surgery varies depending on the surgical method chosen. In rare cases, a second operation may be necessary.