Doc, can you stop tears from running down my face?

This 68 year-old has been troubled by constant watering of the right eye for the past three years. She has seen many eye doctors but despite applying different eyedrops the condition fails to improve. Syringing of the nasolacrimal duct reveals blockage of the nasolacrimal duct. This condition typically affects elderly woman and thought to be a type of degeneration.  

Figure 1. Normal tear drainage system.

Figure 2. Diagram showing blocked nasolacrimal duct 

causing watering eye. 

Figure 3. Diagram showing how the blockage can be by-passed 

by creating an alternative passage for the tear. 

To bypass the blockage, an alternative passage is created by creating a connection between the lacrimal sac and the nasal cavity. The procedure is called dacryocystorhinostomy (DCR). The steps of the procedure done on this patient are shown in the photos below. The procedure is carried out under general anaesthesia.

Figure 4. a. Marking is done nasal to the right eye; 

b. incision is made and the skin and muscle are pulled away; 

c. an incision is made along the periosteum and peeled away from the bone; 

d. a hole is created by breaking the bone of the nose (rhinostomy); 

e. once the bone is removed the underlying nasal mucosa can be seen; 

f. the nasal mucosa is cut to create an anterior flap; 

g. the lacrimal sac is identified by inserting the lacrimal probes through the nasal puncta; 

h. the lacrimal sac is also cut to create an anterior flap; 

i. to improve the success rate of DCR, silicone tubing is inserted; 

j. the tube is passed from the punta through the lacrimal sac and nasal cavity and out through the nostril; 

k. after the tubing is passed, the anterior flaps of the lacrimal sac and nasal cavity are sutured; 

l. at the end of the procedure, the tubing is removed 6 weeks later. The new passage allowed the tear to bypass the blocked nasolacrimal duct.