Watery eyes and tear duct blockage
What is a nasolacrimal duct obstruction?
Watery eyes and tear duct blockage: Tears are produced by the lacrimal gland, these coat the surface of your eye and then drain through the nasolacrimal system. This system consists of the punctums which are two holes located on the upper and lower lids at the inside corner of your eye. The tears then drain into tiny tubes called the canaliculus, they then drain into a pouch at the side of your nose called the nasolacrimal sac. Finally they drain through the nasolacrimal duct into your nose.
A blockage of the nasolacrimal system can cause watering of the eye. It can sometimes lead to repeat infections (dacryocystitis) or constant production of pus (mucocoele). The most common location of a blockage is in the nasolacrimal duct.
What is an external DCR?
An external DCR is an operation that creates a new drainage passageway for your tears between your eye and nose. This operation can either be done under general anaesthetic or local anaesthetic with sedation.
It involves a 1cm incision on the side of your nose in the area where glasses normally sit. A small amount of bone in this area is removed. Clear plastic stents are placed in the new drainage passageway. If you look closely in the mirror you will be able to see the stents in the inside corner of your eye. It is unlikely that others will notice them. The tubes will be tied inside your nose some people comment that they can occasional feel them.
The incision will either be glued or sutured. If it is sutured the sutures will need to be removed in 7 to 10 days. The plastic stents are removed in clinic 1 to 2 months later.
You may go home the same day, although some people may wish to stay overnight. You will not be able to drive yourself home after the procedure. Please arrange for someone to accompany you home.
What should I do prior to surgery?
If you are taking aspirin or any other blood thinners, you will need to inform your doctor as it is likely that you will need to stop these. This decision is made on an individual basis and you should only do so if it is safe and you have been instructed by your GP, surgeon or anaesthetist. This will be discussed with you before surgery. All herbal medicines should be stopped at least 14 days before surgery.
Smoking impairs healing and if possible you should try to stop 6-8 weeks prior to surgery.
If you have high blood pressure ensure that this is well controlled as it will make you more likely to bleed and bruise.
You should bring a list of your current medications and any allergies with you.
What happens after External DCR surgery?
If you are in any discomfort take painkillers such as Paracetamol or Codeine.
Avoid hot drinks and food for 24 hours after the operation. For 7 to 10 days avoid blowing your nose and sneeze with your mouth open, these measures will help reduce the risk of bleeding.
It is common to have a blood stained drip from your nose which can last a few days, you can dab this gently with a tissue. If you have a more severe nose bleed try to stay calm, sit forward pinch the fleshy part of your nose, try to avoid swallowing blood, place an ice pack over the bridge of your nose, if the bleed does not stop after 30 minutes seek medical attention.
The nose may feel blocked for a number of weeks and there may be scabbing inside the nose try to avoid picking this.
People vary in how quickly the swelling and bruising improves. Bruising will usually improve over 2-3 weeks. Swelling takes longer; most will go away over 3-4 weeks. Swelling and bruising may track to your opposite eye or into your upper cheeks causing swollen lower lid eye bags this will improve over time.
You should rest for 2-3 days after surgery, many people will want 1 to 2 weeks off work. You will be given drops to use for a number of weeks after surgery.
The eye may continue to water while the stents are in place and the swelling and inflammation from the operation settle. If the eye does water wipe inwards to avoid dislodging the stents or dab only on the skin.
The nose scar will fade to a white line over a number of months.
What are the complications of External DCR surgery?
- Bruising and swelling – this happens after the operation in everyone.
- Nosebleed – a blood stained drip after surgery for a few days is common. A more severe nose bleed is unusual but possible and if it does not stop medical attention should be sought.
- Blurred vision – this is can be due to drops used or continued watering.
- Scarring – wounds heal very well in the majority of people. In rare cases, abnormal scars may result.
- Stent dislocation – The stents can sometimes become more prominent and visible on the eyeball. If this happens try to push the loop back toward and into the nose.
- Continued watering – This operation is usually very successful in improving or stopping watering. Occasionally the new passageway may scar and block again which may need reoperation. Rarely some people may need insertion of a pyrex lester jones tube which stays in place permanently.
Occasionally the operation can be anatomically perfect and the new passageway open but watering can still continue. This may happen if there are multiple reasons for watering or if the original blockage is partial or functional. Your doctor will discuss the risk of this prior to surgery.
- Further surgery – occasionally it is necessary to have a further operation.
- Infection – this is rare.
- Corneal abrasion – a scratch to the front of the eye; this can be painful but it will normally heal very quickly.
- Damage to vision – this is extremely unlikely but any surgery near to the eye carries a risk of potential damage to the eye and consequently the eyesight.
