Excessive Tearing can be an extreme nuisance, interfering with vision and damaging to the delicate eyelid skin. The healthy eye normally produces tears to keep the clear surface from drying out. When tears are secreted onto the surface of the eye, the eyelids function to spread the tear film as well as to pump excess tears into the tear drainage system (nasolacrimal system). The nasolacrimal system then drains the excess tears into the nose.

What causes tearing?

The tear drainage system is a complex interaction between the eyes, eyelids, nasolacrimal system and brain. If there is a problem with any component of the system, the result can be excessive tearing.

The most common causes of tearing are; blockage or narrowing of the nasolacrimal system, loss of the pump mechanism of the eyelids that “push” the tears into the tear duct, or over-production of tears.

Blockage of the tear drainage system – Nasolacrimal Duct Obstruction

The nasolacrimal system or tear drainage system drains tears from the eye into the nose. If this system becomes narrowed or blocked, the tears will back up and spill over the eyelid and down the face. A blocked tear duct (nasolacrimal duct obstruction) not only can cause tearing, but an infection in the system as well (dacryocystitis).

Blockage of the tear drainage system can occur anywhere along its pathway, but commonly is blocked within the nasolacrimal sac, the portion of the tear drainage system between the eye and the nose. Depending on the location of the obstruction, a test of the system is performed during examination to determine the site and severity of the obstruction.

What Are Symptoms of an Infected Nasolacrimal Sac – Dacryocystitis?

When a nasolacrimal system blockage is severe enough to completely block tear drainage, an infection can develop within the nasolacrimal sac (dacryocystitis).  Dacryocystitis most commonly presents with excessive tearing, mucous discharge, eye irritation, and a painful swelling in the inner corner of the eye. If the infection goes untreated, it can spread around the eye and face. Initial treatment is with antibiotics but ultimately surgical drainage is usually required

What is surgical treatment of tearing?

Endoscopic DCR

Treatment of tearing is directed at its cause. If the tearing is caused by an obstruction of the tear drainage system, the solution is surgical. A dacryocystorhinostomy or DCR is the procedure to create a new tear drain between the eye and the nose when the current tear drain becomes blocked. There are two types of DCR surgical methods, external and endoscopic. As an oculofacial plastic surgeon, Dr. Lissauer is trained extensively in nasolacrimal surgery and nasal endoscopic surgery.

In an external DCR, an incision is made in the corner of the eyelid near the nose, the nasolacrimal sac is opened and a temporary soft silicone stent is left in the new tear drain temporarily until the new system is fully healed.

In an endoscopic DCR, a new tear drain is created in a similar manner to an external DCR, but without the need of an incision on the face. An endoscopic DCR utilizes a nasal endoscope (a camera inside the nose) with specialized instruments to repair the nasolacrimal system entirely within the nose. In an endoscopic DCR, there is no visible incision, faster healing and reduced downtime.

How is Endoscopic DCR performed?

Dr. Lissauer performs endoscopic DCR as an outpatient procedure at The Manhattan Eye, Ear and Throat Hospital in New York, with local sedation or general anesthesia administered by an anesthesiologist. The procedure is about one hour.

What Should I Expect After an Endoscopic DCR?

Because there are no visible incisions in an endoscopic DCR and the entire procedure is performed within the nose, no suture removal is required and bruising and swelling generally resolve within three to five days. Light bleeding from the nose is usually present for two to three days after surgery and most patients are able to resume normal activities within one week and are usually able to return back to work in three to five days. Light exercise can usually be resumed within one week and full exercise within two weeks.

If you would like to schedule a consultation with Dr. Lissauer regarding Endoscopic DCR tear drainage surgery, please contact our New York office at: 212-717-2150 for an appointment.