TEAR DUCT SURGERY
- Yetişkinlerde aşırı göz yaşarması, genellikle gözyaşı drenaj sistemindeki tıkanıklıklar veya tahrişe bağlı aşırı üretimden kaynaklanmaktadır.
- Gözyaşı kanalı tıkanıklığının teşhisinde boya testi, sondalama ve yıkama yöntemleri kullanılarak tıkanıklığın tam yeri belirlenir.
- Tam tıkanıklık durumunda uygulanan DCR cerrahisi ile gözyaşı kesesi ve burun arasında yeni bir kanal açılarak normal drenaj yeniden sağlanır.
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Understanding Excess Tearing in Adults
Excess tearing in adults is a common condition that typically arises from two primary issues: poor tear drainage or an overproduction of tears. Tears are produced in the tear gland and are essential for maintaining eye health by providing necessary lubrication. When the eye becomes irritated, it naturally produces excess tears as a protective response. Interestingly, patients may not always feel the irritation itself but will notice the resulting watery eyes.
The Anatomy of the Tear Drainage System
To understand why tearing occurs, it is important to know how the drainage system functions:
- Initial Drainage: Tears enter small holes located in the inside corners of the upper and lower eyelids.
- Collection: They collect in the tear sac, which sits under the skin between the eye and the nose.
- Flow: Tears then travel through the nasolacrimal duct into the nose.
- Pumping Mechanism: The simple act of opening and closing the eyes pumps tears through this system.
Any blockage within this pathway prevents normal drainage, causing tears to overflow onto the cheek.
Diagnosis of Tear Duct Blockage
Properly identifying the specific site of the blockage is critical for determining the correct treatment. Specialists use several diagnostic methods:
- Dye Test: A harmless orange dye is placed in the eye to observe drainage efficiency.
- Probing: A thin metal tube is inserted into the system to check if the tubes leading to the tear sac are open.
- Flushing: The doctor attempts to flush water through the nasolacrimal duct to confirm it is clear.
In many cases, patients suffer from a combination of factors, such as partial blockage, eyelid weakness (poor pumping), and irritation-induced overproduction simultaneously.
Treatment Options for Tear System Blockage
Treatment varies depending on the severity and location of the obstruction:
Partial Blockage and Medical Management
If the duct is only partially blocked, doctors may attempt to widen the opening by flushing it with water. Following this, anti-inflammatory and antibiotic eye drops are prescribed to reduce swelling and promote drainage. While often successful, these procedures may need periodic repetition.
Surgical Intervention: DCR (Dacryocystorhinostomy)
When the nasolacrimal duct is completely blocked, a surgical procedure known as DCR is required.
- Procedure: A new opening is created between the tear sac and the inside of the nose.
- Complex Cases: If the cannaliculli (tubes leading to the sac) are blocked, reconstruction is performed alongside the DCR.
- Eyelid Issues: If tearing is caused by eyelid malposition, surgical tightening and repositioning are necessary.
The DCR Surgical Procedure
DCR is performed as a same-day procedure under either general anesthesia or sedation. The surgeon makes a small skin incision on the side of the nose and removes a small piece of bone to connect the tear sac lining directly to the nasal lining.
In some instances, a clear plastic stent (tube) is placed in the drainage system to prevent scarring. This tube is easily removed in the office after two months. Skin sutures are typically removed within one week. While the resulting scar may initially appear red or raised, it will smooth out over the following months.
Post-Operative Care and Instructions
To ensure successful healing and prevent complications like nosebleeds, patients must follow specific guidelines:
| Category | Instructions |
|---|---|
| Nasal Care | Do not blow your nose for 5 days. Keep the nasal lining moist using a humidifier. |
| Activity | Only light activity for the first 48 hours. Continue all blood pressure medications. |
| Bleeding | If mild bleeding occurs, sit upright and pinch nostrils for 10 minutes. |
| Swelling | Apply cold compresses or ice packs at least 4 times daily for the first 2 days. |
Medication and Wound Maintenance
- Ointments: Apply antibiotic ointment to the wound three times daily until sutures are removed.
- Eye Drops: Use antibiotic/anti-inflammatory drops three times daily for two weeks.
- Cleaning: If dried blood accumulates, clean the wound gently with peroxide on a Q-tip.
- Restrictions: Avoid swimming, yard work, or getting the wound dirty for two weeks. You may wash your hair or bathe starting the day after surgery.
Expert Contributor: Op. Dr. Ahmet UMAY, Bristol University Ophthalmology Section, UK.
Resources: Bristol University Literature; Eye Consultants of Pennsylvania.
