Endoscopic Tear Duct Surgery

Tears drain from the eye into the nose. When the duct that carries them blocks, the eye waters all the time and the tear sac becomes infected again and again. If the duct cannot be opened with medicine or with dilation, the surgeon opens a new passage from the tear sac into the nose.

An ophthalmologist investigates the tear sac, makes the diagnosis and decides whether surgery is needed. The classic technique needs a cut on the face. The surgeon finds the tear sac and opens its inner wall into the nose.

Tear duct surgery through the nose returned about twenty years ago, after endoscopic sinus surgery came into use, and it is now used more and more.

The endoscopic operation

The ophthalmologist and an ear, nose and throat surgeon experienced in endoscopic surgery do the operation together. It is called endoscopic dacryocystorhinostomy.

The surgeon reaches the lacrimal bone, which sits between the tear sac and the nose, through the nose. The bone is passed, the tear sac is found, and its inner wall is opened. Silicone tubes are then passed through the tear duct openings at the inner edge of the upper and lower eyelids, brought out inside the nose and fixed there. How long the tubes stay depends on the condition, and it is between 2 and 12 months.

Success and technology

No meaningful difference in success has been found between the classic and the endoscopic operation. The rate is around 90 to 95 per cent for both.

Endoscopic technology has moved on in recent years. Lasers and microdebriders make passing the lacrimal bone from inside the nose much easier. Surgical navigation systems show the exact position of the anatomy during the operation. Together these lower the complication rate and shorten the operation considerably.

The advantages

The endoscopic operation leaves no scar on the face and does not disturb the structures around the eye.