Epiphora (AKA excessive tearing or watery eyes) is typically caused by an obstruction or dysfunction in the normal tear drainage system. The management of epiphora involves identifying and addressing the underlying cause. This can include treatments such as warm compresses, eyelid hygiene, and the use of lubricating eye drops to alleviate symptoms. In cases where the blockage or dysfunction persists, further interventions may be required, such as tear duct probing, stent placement, or surgical repair of the tear ducts to restore proper tear drainage and alleviate the excess tearing.

Dacryocystitis is an inflammation or infection of the nasolacrimal sac, which is the part of the tear drainage system that collects tears from the eye. It typically occurs when there is a blockage or narrowing of the nasolacrimal duct, causing the tear fluid to accumulate and become stagnant, leading to infection. The management of dacryocystitis involves both medical and surgical approaches. Initially, warm compresses, antibiotics, and nasal decongestants may be prescribed to reduce inflammation and control the infection. However, if the infection persists or recurs, surgical intervention may be necessary. The most common surgical procedure for dacryocystitis is dacryocystorhinostomy (DCR), which involves creating a new drainage pathway for tears to bypass the blocked tear ducts. This allows for proper drainage and prevents future episodes of dacryocystitis.

Surgical Procedures for Lacrimal Problems

Some of the most common lacrimal procedures performed are as follows:

1. Probe and Irrigation: A probe and irrigation of the lacrimal system is a diagnostic and and therapeutic procedure (in kids) performed to evaluate blockages or obstructions in the tear drainage system. A thin, flexible probe is inserted into the lacrimal ducts to assess their patency, and saline solution is irrigated through the system to identify any blockages and their location within the nasolacrimal system. In children, it is also done to alleviate symptoms of epiphora (excessive tearing) and assess the need for further intervention or surgical management.

2. Canaliculotomy: A canaliculotomy is done when you have an infection within the canaliculus, called canaliculitis. A canaliculotomy involves creating an incision in the canaliculus, the small channel that drains tears from the eye into the lacrimal sac. This procedure is performed to remove infections and stones in the canaliculus, allowing for improved tear drainage and alleviating symptoms of epiphora.

3. Plastic repair of the canaliculus: This procedure is done when you have an obstruction or laceration within the canaliculus. In this procedure we reconstruct or repair a damaged or severed canaliculus by rejoining or reconstructing the canaliculus using specialized sutures or stents to restore normal tear drainage and prevent epiphora.

4. Dacyrocystorhinostomy (DCR): External DCR and endoscopic DCR are both surgical procedures used to treat blockages or obstructions in the tear drainage system. An external DCR involves creating a small incision on the side of the nose near the inner corner of the eye. The surgeon then creates a new passage by connecting the tear sac directly to the nasal cavity under direct visualization, bypassing the blocked or narrowed tear ducts. This allows tears to drain properly from the eye into the nasal cavity, relieving symptoms of epiphora or infection within the nasolacrimal sac. An endoscopic DCR is a minimally invasive technique performed using a nasal endoscope, which is a thin tube with a camera. The surgeon makes a small incision inside the nose, avoiding an external scar and inserts the endoscope to visualize the blocked or narrowed area. They then use specialized instruments to create a new passage connecting the tear sac to the nasal cavity, similar to external DCR. Both procedures have the same goal of restoring normal tear drainage. The choice between external DCR and endoscopic DCR depends on factors such as the individual patient's anatomy.

5. Conjunctivodacryocystorhinostomy (CDCR): CDCR is a surgical procedure performed to bypass blockages or obstructions in the tear drainage system when the lacrimal system is compromised or absent. Unlike traditional DCR procedures, which connect the tear sac to the nasal cavity, CDCR involves creating a new drainage pathway directly from the conjunctival sac (the space between the eyelid and the eye) to the nasal cavity, followed by placement of a Pyrex glass tube to drain the tears, called a Lester Jones Tube (Jones tube for short). This procedure is typically considered as a last resort when the tear drainage system cannot be used or is inadequate for tear drainage. CDCR can help alleviate symptoms of epiphora (excessive tearing) by establishing an alternative route for tears to drain from the eye into the nasal cavity.