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21/06/2018

The lacrimal duct is a tube-shaped drainage system that catches tears through small openings (called lacrimal punta) in the nasal extremity of both eyelids and channels them to the nose as if it were a drainage pipe.

If the lacrimal duct is blocked at any point, the tears overflow and the patient cries.

Upper obstructions (proximal) located in the lacrimal punctum may be treated with cortisone eyedrops, if the obstruction is caused by oedema (swelling) or the use of the punctoplasty surgical technique which widens the opening.

When the lacrimal system blockages are located in a deeper position, known as lower obstructions (distal), they will always require a surgical procedure called a dacryocystorhinostomy. There are various approaches for creating a new opening to facilitate the flow of the tears to the nasal cavity. None of these techniques has a 100% success rate because the patient's own healing process means that in a small percentage of operated cases the opening may close over time and the tearing return. To avoid this to the fullest extent possible, a silicone tube is put in place for a few months after the operation.

In an external dacryocystorhinostomy, a small incision is made in the patient’s skin and used to produce an opening reconnecting the lacrimal duct to the nose. To do this, we hide the incision in the lacrimal sulcus (groove). Due to the fact that this procedure is performed through the skin, the hole or osteotomy might be larger than in other surgical techniques. The creation of an opening gives the lacrimal system improved permeability after the wound heals. The success rate is 90%.

In a transcanalicular diode laser dacryocystorhinostomy, the patient’s lacrimal system is also connected to the nose with the help of a small diode laser probe inserted into the lacrimal puncta, so that the resulting osteotomy is smaller than that of the external technique, but we manage to avoid damaging the eyelid skin. The success rate is approximately 70%.

Dra. Marta López-Fortuny

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