Lacrimal System Procedures
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:
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.
© 2021 American Academy of Ophthalmology
Depending on where the blockage of the drainage pathway is located, some of the most common options for treatment include:
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.
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.
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.
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.
Since Dr. Liu prefers to perform lacrimal surgeries minimally invasively or endoscopically, there is no visible scarring on the skin.