Tears are made primarily by the lacrimal gland, which is in the
upper lateral aspect of the upper eyelid. With each blink, tears
are drained from the eye through the tear drainage system, into
the nose. There are normally two openings to the tear drainage
system; one in the upper eyelid and one in the lower eyelid. These
tiny orifices are situated along the margin of the eyelid, closest
to the nose, and are known as puncta. The puncta lead to tiny tear
ducts which lead to the inside corner of the eye, then in tears
are carried from the tiny tear ducts into the nose. It is usually
toward the bottom of the ducts(nasolacrimal duct)that obstructions
of this passageway occur.
When an individual develops tearing due to acquired obstruction
of the nasolacrimal (tear) duct, a DCR procedure is usually offered.
However, diagnosis of the condition must be made first, and this
usually requires one or more in-office tests by the ophthalmologist.
If the nasolacrimal duct is determined to be relatively or completely
obstructed, a DCR procedure is often appropriate.
The DCR Procedure
In this procedure, the tear drainage pathways are reconnected to
the inside of the nose. A small incision is usually placed approximately
midway between the corner of the eye and the bridge of the nose.
The lacrimal sac is located, incised, and then connected to the
nasal mucosa creating a new tear drainage pathway. Tiny plastic
tubes (stents) are then placed in the newly created tear drainage
pathway for a few months to prevent scarring of the tear drainage
ducts, which might otherwise result in failure of the surgery.
The tubes can usually be removed in the office with little if any
discomfort or need for anesthesia.
The Balloon (Non-Incisional) DCR
A balloon DCR is similar to the incisional DCR in objective, although
the procedure is completed without an incision. The surgeon advances
tiny tubing through the blocked tear duct, utilizing an inflatable
balloon to help create a new tear drainage pathway into the nose.
The inflatable balloon is the same type of balloon used in coronary
(heart) artery angioplasty procedures. The surgeon then places
thin plastic tubing in the newly created tear duct system, which
is generally removed in the office 4 to 6 months later. Removal
of the tubing causes little if any discomfort and typically does
not require anesthesia.
If you’ve been troubled or embarrassed by tears running down your
face, consider an examination with our oculoplastic surgeon in
consideration of one of the latest DCR procedures. These advanced
procedures performed by experienced surgeons offer tremendous potential
to effectively and permanently resolve your tearing, in some cases
without even so much as an incision!
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