Tear Excretion System

The tear duct system consists of tear ducts, which open into two initial orifices on the inner side of the upper and lower eyelids, the tear sac, and a thin tear duct. This system ends by opening into the nasal cavity. Our tears regularly wash and lubricate our eyes with blinking, enabling clear vision. Harmful substances in front of the eye are cleaned away by tears through the tear duct. Blockages at any point along this drainage system cause watery eyes and discharge. Initially, watery eyes begin to appear upon going outside, especially in windy and cold weather, and then the watering becomes constant. Tears that accumulate and cannot be drained create a suitable environment for microbes. Like unclogging a plumbing system, the blocked area must first be cleared, and then a DSR (Deep Tear Suppression Surgery) procedure must be performed.

If a patient needs intraocular surgery such as cataract, glaucoma, or retinal surgery, these surgeries cannot be performed without relieving the tear duct blockage. If the tear duct blockage is not relieved, inflammation of the tear sac may occur. However, since it is impossible to predict which patient will and will not develop tear sac inflammation, when it will occur, and the success of DSR surgery decreases when the sac becomes infected, performing this surgery before inflammation occurs is necessary for a better surgical outcome.

Tear Duct Obstruction

Acquired Tear Duct Obstructions

1. Narrowing or closing of the tear duct
2. Blockage of tear ducts
3. The tear sac becoming filled with lumps or stones.
4. Tear duct blockage.

It is more common in women. Surgical treatment is applied.

Narrowing or closing of the tear duct

Dacryocystorhinostomy

In adults, the blocked portion of the tear duct is bypassed, creating a new channel between the tear sac and the nose. The surgery can be performed externally through the skin or internally through the nose. External DSR (ext-DSR) surgery, performed externally through the skin, may leave a scar, but the success rate is higher. Because the surgeon can directly see inside the tear sac, the ext-DSR method allows for the detection of stones, masses, tumors, etc., within the sac, enabling differential diagnosis. Sometimes, a silicone tube may be placed in the duct during DSR surgery. This type is removed in an outpatient setting after 3-6 months.

THINGS TO DO TO LEAVE NO TRACES

With careful surgical techniques and special sutures (stitching threads), the likelihood of scarring is reduced. The patient’s skin type is a significant factor in determining whether or not scarring occurs. Additionally, scar-reducing creams can be started 15 days after surgery to minimize the possibility of scarring. If a scar remains, it is usually located below the point where the eyeglass frame touches the nose in people who wear glasses. Healing of the wound tissue after the procedure takes at least 6 months. Sun protection is very important during this period. Protect the area with sunglasses or sunscreen for at least 12 months. Avoid scratching the treated area and avoid harsh movements when applying makeup.

Prolonged exposure to sunlight, smoking and alcohol use, irregular sleep, and air pollution are just some of the many factors that negatively affect the wound healing process, so it is important to be mindful of these issues.

1. A. YAZICI, A. ALTINOK, Emine ŞEN, et al.  Single Posterior Flap External Dacryocystorhinostomy Surgery and Silicone Tube Intubation. MN Ophthalmology 2013;20(1): 50-55.
2. Ceylanoglu KS, Acar A, Emine ŞEN. Overview of EpiphoraReferred to Oculoplastic Surgery Clinic in Adults. Beyoglu Eye J. 2023;8(1):45-49. 

3. FÇ EROĞLU ,  Emine ŞEN , et al. Ideal Surgery and Timing for Removal of Mini-Monoca Tube in Canalicle Injuries: A Cross-Sectional Study. Turkiye Klinikleri J Ophthalmol. 2024;33(2):87-93