Endoscopic Dacryocystorhinostomy (DCR) for blocked (clogged) tear duct.  

Excessive tearing can be caused by multiple factors.  Tears are produced by the lacrimal gland and drain through tiny channels in the eyelids called canaliculi.  From the canaliculi, the tears drain through the lacrimal sac and nasolacrimal duct into the lower part of the nose.  There can be too much tear production or a blocked tear outflow system.  The consequences of excess tearing from a blocked tear duct includes persistent blurred vision, tears running down the cheek and chronic red eye.   Shown below is a diagram of the lacrimal (tearing) system.

Diagram of the Lacrimal System

A blocked tear duct typically occurs at the nasolacrimal duct as shown in the figure above.  During your evaluation, a complete examination of the entire lacrimal system will be performed to determine if your tearing comes from excess production, blockage of outflow or even both.  With a clogged tear duct, you may experience continuous irritation of the affected eye, sticky or matted eyelids, and even vision threatening infections such as dacryocystitis as shown below. 

Picture of patient with acute left dacryocystitis

MRI scan of the orbit showing the abnormally dilated lacrimal sac.

This image above is an MRI scan through the orbits (eye socket), eye and nose.  As shown on the right side of the picture in the red arrow, the lacrimal sac is dilated (shown in cross section) from a chronic infection.  On the left side of the picture, the normal lacrimal sac is represented by a dark circle.  Note that a MRI scan is rarely indicated for a patient with typical symptoms of a nasolacrimal duct obstruction (blocked tear duct).  

The mainstay of treatment for a blocked tear duct is a procedure called dacryocystorhinostomy or abbreviated DCR.  In the DCR procedure, a new tear channel is created bypassing the obstruction at the nasolacrimal duct.  

The traditional technique for DCR surgery is the external technique.  In this technique, a scar is made parallel with the nose overlying the lacrimal sac.  The external technique is a successful procedure however, the main drawback is that a skin incision must be made.  In some patients, this may lead to a post-operative scar as shown in the picture below.  

Scar formation after external DCR surgery (photo courtesy of N. Wanumkarng, M.D.)

Because of the possibility of this visible scar, Dr. Korn uses the endoscopic approach for tear duct reconstruction (DCR surgery).  In this approach, a tiny high definition (HD) camera mounted on a long scope is used to perform the surgery from within the nose bypassing the need for a skin incision.  This outpatient surgical procedure typically takes less than 1 hour and patients are discharged home in the same day.  The recovery from endoscopic DCR surgery is often faster than traditional external (skin incision) tear duct surgery.  

Picture showing surgeon's view inside of the nose during endoscopic DCR surgery

During the surgery, Dr. Korn will place a tiny silicone tube, also called a stent into the upper and lower tear channels (canaliculus) and this will communicate with the inside of the nose.  It is important to leave the stent in place for at least 3 months after the surgery to ensure the highest level of success.  The stent is visible in the inner corner of the eyelid as shown below and is hardly noticeable by the majority of patients.  

Silicone stent visible in the inner corner of the eyelid (black arrow)

The purpose of the stent is to help keep the newly created tear duct open.  A simple analogy is that after an ear is pierced, an ear ring must be left in place to keep the piercing open.  In this same manner, the silicone stent keeps scar tissue from closing off the newly created tear duct.  The other end of the stent is anchored to the inside of the nose.  Both ends of the stent (in the nose and eyelid) should not be pulled on or cut as this will lead to extrusion of the stent and need for premature removal. This can lead to a lower rate of surgical success.  After about 3 months, Dr. Korn will remove the stent in the office.  This procedure is quick and often painless without the need for another visit to the operating room.  

 

Shown above is a video of a patient that Dr. Korn performed endoscopic tear duct reconstruction (dacryocystorhinostomy). When yellow dye (fluorescein) is placed onto the eye surface, the fluid can clearly be seen flowing through the new ostium (tear duct).  

To schedule a consult with Dr. Korn for endoscopic tear duct reconstruction, please contact our office.