Lacrimal surgery involves the tear drainage system, the plumbing that drains tears from the eye to the back of the nose. Narrowing or blockage of the tear drainage system commonly presents as “epiphora” (tearing). Another common symptom resembles recurring conjunctivitis.
The causes of tearing are numerous and represent an imbalance between tear production and drainage. Assessment involves determining if the imbalance is caused by a plumbing issue or not. Blockage of the lacrimal duct can lead to chronic conjunctivitis, morning eyelid sticking and cellulitis. A recent study has suggested that lacrimal duct obstruction increases the risk of endophthalmitis after cataract surgery.
Dacryocystorhinostomy is the major tear duct drainage operation. This can be performed via an external incision on the side of the nose or entirely from the inside of the nose. The endonasal approach has the benefit of a gentler recover, shorter anaesthetic time, no external scarring, less bleeding and excellent success rates. Dr Smith performs this surgery endonasally.
Jones Tube insertion is a glass bypass tube that is recommended in special circumstances of poor lacrimal drainage. Dr Smith has years of experience in inserting and maintaining and replacing these tubes which often require lifelong periodic maintenance and review.
Other types of lacrimal surgery include enlarging narrow punctal openings, repairing lacerations through the eyelid involving the tear drainage system or probings for children with congenital nasolacrimal duct obstruction. Some causes of watery eyes are due to eyelid problems which Dr Smith also specializes in correcting.
Non-structural causes of epiphora are often managed with eyedrops.
During your consultation, to establish the likely cause of your symptoms, it is necessary to perform a thorough examination of your eyelids, eyes, nasal passage and tear film. This will include a probing and syringing with saline of your tear duct system.