Lacrimal System Procedures

What causes tearing?

When you experience tearing, it typically is either due to an overproduction of tears, tears not draining properly out of your eyes, or a combination of the two. Your eyes may overproduce tears if you have dry eyes, allergies, eye surface irritation, infection, or inflammation. We usually treat these conditions with over-the-counter medications, such as artificial tears, allergy drops, anti-inflammatory drops, or oral medication, although some patients require antibiotic drops.

If you aren’t experiencing the issues discussed above, your tears may not be draining out of your eyes correctly. We produce tears constantly throughout the day, but you don’t typically notice because tears drain into the lacrimal system. These issues are slightly more difficult to diagnose, but usually fall into one of several categories:

If the eyelids are not sitting in their proper position, this can cause eye dryness or irritation. Additionally, the two small tear drains (puncta) on the upper and lower eyelids may not be in the proper position to allow drainage of tears from the eyes – a condition that is usually solved through either ectropion surgery or entropion surgery.
Blockage at any point of the tear drainage pathway can lead to tearing. In addition to tearing, blockage at certain points of the pathway can also lead to recurrent infections with symptoms such as discharge from the eye or a red bump in the area between the eye and nose.

As shown in the diagram below, in a normally functioning lacrimal drainage system, the tears will leave the eye from the two small tear drains (puncta) then travel through two small tear tubes (canaliculi) before emptying into the tear sac (lacrimal sac) and then ultimately passing through the duct (nasolacrimal duct) into the nose.

How do we treat blockages of the tear drainage system?

Depending on where the blockage of the drainage pathway is located, some of the most common options for treatment include:

Tear drains (puncta) are too small – a punctoplasty can be performed to open up the puncta and allow tears to drain more easily
Partial blockage of the tear tubes (canaliculi) – probing followed by the placement of a small tube (stent) can be used to open the blockage up
Blockage in the tear sac (lacrimal sac) or in the tear duct (nasolacrimal duct) in an adult – the preferred treatment is dacryocystorhinostomy (DCR) surgery to create a new pathway for the tears to drain into the nose
Blockage of the tear duct (nasolacrimal duct) in an infant or child – probing followed by the placement of a small tube (stent) can be used to open the blockage up
Complete blockage of the tear tubes (canaliculi) or unsuccessful lacrimal surgeries – a conjunctivodacryocystorhinostomy (CDCR) surgery can be performed with the insertion of a glass tube (Jones tube) directly from the corner of the eye into the nose for tears to drain

What to expect for your visit?

During your initial office visit, Dr. Liu will determine where the blockage is located in the lacrimal drainage pathway. She may perform a diagnostic test called lacrimal probing and irrigation where a saline solution is flushed through the lacrimal drainage pathway to see if there is a blockage. If there is no blockage then no further procedure is typically needed. If there is a blockage, an additional procedure may need to be performed either in our office or scheduled at an outpatient surgery center.

Commonly asked questions

What kind of anesthesia is used during lacrimal system surgery?

Certain types of lacrimal system surgery such as punctoplasty or lacrimal stent placement can be performed using local anesthesia in Dr. Liu’s procedure room or under IV (intravenous) sedation at an off-site surgery center. For your comfort, DCR and CDCR surgeries are typically performed under general anesthesia at an outpatient surgery center where you can go home the same day.

How does Dr. Liu perform lacrimal system surgery?

Depending on the location of the tear drainage blockage, Dr. Liu will select the specific techniques that are suited for your needs. DCR and CDCR surgeries can be performed using an endoscopic approach with a camera inside the nose or an external approach by cutting through the skin between the eye and nose, Dr. Liu prefers to perform the surgeries endoscopically if possible to avoid leaving a scar on the face. With several of these lacrimal system procedures, a fine clear silicone tube is placed through the lacrimal drainage pathway to keep it open for 1 to 6 months.

How long does the procedure take?

Office procedures such as the punctoplasty or probing with stent placement can usually be performed in less than a half hour. DCR and CDCR surgeries typically take about 1-2 hours from start to finish.

Does lacrimal system surgery scar?

Since Dr. Liu prefers to perform lacrimal surgeries minimally invasively or endoscopically, there is no visible scarring on the skin.

Dr. Liu is one of the most professional doctors I have met. She is done two surgeries on me, and I love her work, especially the results. She is through, takes the time to explain what is anticipated and answers all questions. I could not have asked for a better physician. Her office staff is the best, and so upbeat. I cannot say enough wonderful things about Dr. Liu and her staff.

Mary
Laguna Niguel

Dr. Liu is the top rated oculoplastic surgeon in Orange County.

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