Nasolacrimal duct obstruction

One of the symptoms affecting the eye and worrying people is excessive watering of the eyes. Although in many situations involving exposure to the cold or wind it's normal and very common for the eyes to water, there are people who constantly face this issue. 

It's called epiphora or constant eye watering due to a drainage issue, which makes daily activities difficult and becomes a pathology that needs to be seen to by an ophthalmologist.

The tear duct is a tube-shaped drainage system that collects tears using small orifices (names lacrimal punctum) in the side closest to the nose of both eyelids and sends it to the nose. 

The tears that have not evaporated empty out the nose through a system consisting of tubes, canaliculi (in the eyelids), the lacrimal sac, and the nasolacrimal duct. 

Obstruction of this tube system causes an accumulation of tears that the nose cannot drain. The eye has excess water and it fails to eliminate all types of debris.  

If the tear duct is blocked at any point in its trajectory, the tear overflows and the patient cries.

Obstruction of the tear duct could be for different reasons (age, nose trauma, nasal allergies, conjunctivitis, a tumour).  

In children, obstruction of this conduct could be due to the fact that it did not develop correctly at birth. It is important to see an ophthalmologist as soon as possible to determine the best course of treatment.

Symptoms

• Eye watering, blurred vision, eye irritation or conjunctivis 
• Mucous secretion, lacrimal sac inflammation (internal angle of the eyelid) 
• Skin maceration

High obstructions (proximal) that are located in the lacrimal punctum may be treated with cortisone eyedrops if the obstruction is due to oedema (swelling) or with punctoplasty, a surgical techique used to widen the drain opening. 

When lacrimal system obstructions are located deeper, also known as low obstructions (distal), they always require surgery known as a dacryocystorhinostomy (DCR). There are various alternative approaches for making a new drainage opening to the nasal cavity in order to get round the obstruction the obstruction created. 

Dacryocystorhinostomy (DCR) 
It involves making a new bone window in the lacrimal bone which joins the lacrimal sac to the bone, in order to get round the obstruction created. 

Classic or external DCR
A small incision is made in the skin to make an orifice that connects the tear duct to the nose again. 

Because it is done through the skin, this technique can make the hole or osteotomy larger in size than other techniques can. Making a larger hole provides the lacrimal system with better permeability after the healing of the wound. 

Diode laser-assisted DCR
It is performed with laparoscopic tecniques, using a camera and a television screen. 

A connection with the lacrimal system and nose is created with the help of a small diode laser probe which is inserted into the lacrimal punctum in such a way that the resulting osteotomy is smaller than the external technique but we avoid making a wound on the eyelid skin.