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Tearing Conditions

The tear drainage system is prone to a number of problems from infection to blockage. Dr. Lensink treats a wide variety of conditions associated with this system.

Dacryocystitis

Patient Photo with Dacryocystitis
Photo of a patient with Dacryocystitis

The eye's tear drainage system collects tears through small openings in the inner corners of the eyelids from where they ultimately drain into the back of the nasal passages. A small sac within this system rests between the eye and the nose slightly beneath the skin. Inflammation (nearly always associated with infection) of the tear drainage sac is termed dacryocystitis (dāk'rē-ō-sĭ-stī'tĭs). This infection is typically due to a blockage in the tear drainage (nasolacrimal) duct beyond the location of the infected sac.

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In much the same manner that a stagnant swamp develops when a body of water has nowhere to drain, an infection (dacryocystitis) often develops when the tear drainage duct is blocked. Treatment of dacryocystitis involves first, treatment of the infection and second, fixing the obstruction that leads to the infection.

Mild cases of dacryocystitis can sometimes be treated with antibiotic drops and antibiotic pills. An abscess might develop over the tear sac. This is often best treated by draining the abscess through a small opening in the skin overlying it. Severe cases of dacryocystitis may require hospitalization and intravenous antibiotics.

Once the infection has cleared surgery is typically performed to permanently bypass the obstructed tear drainage duct. Dacryocystorhinostomy (DCR) surgery is commonly the treatment option of choice.

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Nasolacrimal Duct Obstruction

Patient Photo with Nasolacrimal Duct Obstruction
Pooling of Tears Containing Diagonstic Tear Dye, Right Eye Due To Nasolacrimal Duct Obstruction

Nasolacrimal duct is the term given to the duct which connects the tear collecting apparatus in the inner corner of the eye to the nasal passages. It is a very common location for blockage in the tear drainage system. When blockage occurs, tears have nowhere else to drain but to run down the cheek.

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While the most frequent symptom of nasolacrimal duct obstruction is tearing, a relatively common and more serious finding is dacryocystitis. Click here or see  the condition above for more about dacryocystitis.

Treatment of nasolacrimal duct obstruction depends upon age. Sometimes at birth, a membrane over the opening between the nasolacrimal duct and the nasal passage is present. This membrane occasionally opens spontaneously in the first year of life. When it does not, a simple probing of the nasolacrimal system under anesthesia to perforate the membrane usually clears the blockage. If probing alone fails or when the child is slightly older, probing may be accompanied by placement of very small tubes in the tear drainage system for several months so the perforation in the membrane does not heal over.

In older children and adults, a surgical procedure known as dacryocystorhinostomy (DCR) is performed. We prefer to undertake this procedure in an outpatient surgery center. DCR is straightforward surgery which permanently resolves tearing in 90% of cases.

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Punctal Stenosis

Patient Photo with Punctal Stenosis
Photo of a patient with Punctal Stenosis

Small openings in the inner corner of the upper and lower lids collect tears for drainage ultimately into the nasal passages. These openings may spontaneously close, essentially plugging the tear drainage system and causing tears to run down the cheek.

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Reopening these passages is typically performed in our office undertaking a minor procedure called punctoplasty. Techniques vary slightly depending on the severity of the blockage. Punctoplasty may be as simple as gently forcing a sterilized probe through the obstruction. It may be modestly more complicated. Recovery usually involves no more than eye drops for a few days

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Punctal Ectropion

Patient Photo with Punctal Ectropion
Photo of a patient with Punctal Ectropion

The punctum, or tear drainage opening in the inner corner of the eyelid is responsible for collecting tears that drain into the nasal passages. When the inner portion of the lower eyelid pulls away from the eye even slightly, it pulls the drainage punctum out of position so that it can longer collect tears. This causes tears to run down the cheek.

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Treatment of punctal ectropion varies depending on the severity and cause of the problem. In mild cases a minor office procedure called punctoplasty is performed to enlarge the punctum, allowing it to more effectively collect tears.

In more severe cases, one of several outpatient surgical procedures is undertaken to return the eyelid to a normal anatomic position wherein the eyelid and punctum lay against the eye.

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