How Tears Are Produced
Tears are usually produced to humidify the external surface of the eye and are eliminated through a series of ducts that cross the eyelid and the bones of the nose. In every eyelid, there is a lacrimal punctum that forms the access to a tear duct. The superior and inferior tear ducts join into a common duct that leads to the lacrimal sac. The lacrimal sac grows thinner in its inferior part and continues into the nasolacrimal duct that ends in the nose.
Nasolacrimal Duct Obstruction
The partial or total occlusion or stenosis of the tear ducts is a frequent and particularly irritating pathology that affects patients of every age, from new-born children to elderly people. It causes a symptom called epiphora, which provokes constant lachrymation. In some cases, it is associated with infections of the lachrymal apparatus. In most cases, an eye examination can reveal this problem. A simple lavage of the tear ducts is sufficient enough to ascertain the total occlusion. The lavage is carried out in the clinic and is not painful. It is intended for diagnosis and not as a treatment. According to where the occlusion is located, the solution (which is a surgical operation) can be more or less invasive.
How Is Nasolacrimal Duct Obstruction Treated
The surgery, more or less invasive depending on the location of the obstruction, is the most suitable treatment for stenosis.
- Punctum Surgery
Punctum surgery is an operation carried out under local anesthetic in the operating room that involves the dilating of the obstructed lacrimal punctum. This operation has a very high success rate and can foresee the introduction of silicone braces that are kept for a few months without negatively affecting patients in their ordinary everyday activities.
- Endoscopic Surgery
Endoscopic surgery is a new and advanced method to solve the problem of persistent lachrymation. This operation is carried out in the operating room with local anesthesia. The surgeon progressively dilates the tear duct by using a very thin fiber-optic probe that monitors the tear duct as well as occlusions and blockages, which are removed with specific instrumentation.
- Dacryocystorhinostomy Laser
This is a new endoscopic technique that utilizes a laser diode, which is much less invasive and significantly faster than the traditional one. It is carried out in the operating room with local anesthesia or light sedation. No incision is made but the laser fiber – which is inserted through the inferior lacrimal punctum – emits single pulses (5-6 watts) which in turn react when they come into contact with the involved tissues to free the duct. In order to increase the success rate, a silicone stent can be inserted to maintain the opening carried out by laser, without affecting the patient’s everyday activities. It is removed after 3-4 months.