Treating Nasolacrimal Duct Obstruction or Blocked Tear Ducts

At the University of Utah, surgery for excessive tearing due to nasolacrimal duct obstruction involves a team approach with surgeons who have fellowship training in orbital and sinus specialties. 

Nasolacrimal duct obstruction, which can be related to thyroid eye disease, is treated through a coordinated multi-specialty practice between ophthalmologists (eye doctors) and rhinologists (endoscopic sinus surgeons).

lacrimal anatomy

What Causes Blocked Tear Ducts?

Normally, tears from the eye drain into the nose (nasal cavity). Tears come from the lacrimal gland (the lacrimal gland is located at the upper outer area of the eye). As tears cross the eye with each blink, they move toward small openings in the eyelid corners called puncta. From the puncta, tears travel through a pathway known as the canalicular system (superior and inferior lacrimal canals) into the lacrimal sac. 

The lacrimal sac is between the eye and the nose. It funnels tears into the nasal cavity through the nasolacrimal duct. If the nasolacrimal duct is blocked, it can cause tearing (epiphora). 

Tearing can be treated by creating an opening from the lacrimal sac into the nasal cavity. This procedure is known as a dacryocystorhinostomy (DCR). 

To evaluate tear duct blockage, you may see both an ophthalmologist and an otolaryngologist (ear, nose, and throat doctor). Together these specialists will help determine what treatment is best for you.

Benefits and Risks of Dacryocystorhinostomy (DCR) Surgery

DCR is a fairly simple procedure. The goal of DCR is to bypass the blocked nasolacrimal duct. This will allow your tears to drain directly into the nose from the lacrimal sac.

After the procedure, you can go home on the same day.

DCR has an overall success rate of greater than 90 percent, although the success rate may be lower in particular cases.

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Risks & Side Effects

The risks and side effects of DCR are relatively low. Since it can potentially lead to long-lasting relief of tearing, it can be a good option for patients with thyroid eye disease or Graves’ orbitopathy.

Anesthesia

We put patients under general anesthesia, but you could have local anesthesia depending on your preference or your surgeon’s preference. 

Incision/External Approach

Surgeons can do DCR surgery through a facial incision (external approach). The external DCR approaches the lacrimal sac through a small incision between the eye and the nose. Then we locate the lacrimal sac and open it into the nasal cavity. View Video

Endoscopic Approach

We perform the endoscopic approach through the nose using telescopes and small instruments. Surgeons now prefer this approach because it avoids a facial scar. It could also make recovery less painful after the surgery. Your surgeons will evaluate your tearing and epiphora to determine the best surgical approach for you.

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What to Expect at DCR Surgery

Healing

The majority of the healing in your nose will take place over the next four weeks. In some patients, the process can take longer. Once healed, some patients may feel air in the inside corner of the eye when they sneeze. This is expected and means the newly created passageway is open. 

Medications

You should have received prescriptions for medications to take after surgery. Typically, these include pain medicine and possibly antibiotics. These medications are essential components of your care, promoting rapid and correct healing.

Bleeding

Oozing from the nose is common for 24-48 hours following surgery.

Nausea

Nausea and even vomiting following anesthesia are common. The nausea usually fades after about 12-24 hours. You can try to sip liquids to avoid dehydration during these periods.

Pain

Some discomfort following the procedure is to be expected but usually is not especially severe.

Irrigating

This is one of your most important jobs after surgery. The crusting of blood and mucus can slow the healing process. To keep your nose moist and prevent crusting, you should use saline (salt-water) nasal irrigation following surgery. A simple system to use is NeilMed’s Sinus Rinse, which can be purchased “over the counter” at many pharmacies.   

Fatigue

Fatigue for two or three days following the surgery is common. You will want to take it easy for a few days following surgery. You should also avoid strenuous physical activity. Moderate activity (like going for a walk) is acceptable.

Work

Most individuals return to work within a week following surgery. Some return earlier, some later. Plan to be out for a week and return as soon as you feel up to it.

Travel

Many of our patients travel from some distance. If possible, it is helpful to stay in the local area overnight following the surgery. If necessary, you may travel by air 48 hours after the surgery.

Post-Operative Visits

The care of your sinuses and orbit surgery does not end when the surgery is completed. Post-operative visits are critical. During these visits, your physician will examine your nose. Removal of dried blood and mucus may be necessary while the nose regains its ability to care for itself. 

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