The tear fluid is formed in the lacrimal gland. The blinking of the eyelids distributes the tear fluid over the eye to continuously moisten it. The draining tear ducts begin in the inner corner of the eyelid. They consist of the upper and lower lacrimal puncta and tubules, the lacrimal sac, and the nasolacrimal duct. Constrictions or complete occlusions of the lacrimal ducts can be congenital. However, they usually develop later in life due to inflammation of the conjunctiva and lacrimal sac or result from inflammation of the nose and sinuses. Once the tear ducts are narrowed or blocked, there is a constant, often very annoying trickling of tears. At the Herzog Carl Theodor Eye Clinic, we perform a wide variety of measures to restore regular tear drainage. Most frequently, we use irrigation, probing, dilatation and tear duct splinting.
In all procedures, the most important thing is that the anatomy of the draining tear duct is preserved. Tear duct splinting involves carefully inserting small silicone tubes with probes into the tear ducts, where they remain for several weeks until tear drainage is restored. If the lacrimal sac is completely occluded due to prolonged inflammation, Toti surgery can be used to place an artificial drainage of the lacrimal fluid from the lacrimal sac into the nasal cavity.