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SERVICES: Dacryocystorhinostomy surgery

What causes tearing and how is my tear duct supposed to work?  


In a healthy tear system, your tear gland is responsible for making the tears that smooth the surface of your eye.  The tear gland sits under the upper, outer corner of your eye.  Your eyelids then ‘pump’ the tears to the inner corner where the tear duct resides.  The tear duct takes tears from the inner corner of the eye to the inside of your nose.  That’s why when everything is working correctly, if your eye waters, your nose might run.  


Many patients suffer from excessive tearing.  Sometimes it is severe enough to cause tears to constantly overflow onto the cheeks, significantly interfering with reading, driving or other activities.  


There are three main causes for tearing: 

  • You may be making too many tears

    • This is similar to the faucet of a sink being stuck on high – water ends up on the floor

    • Like the faucet, if your tear gland is overactive, you might end up with tearing

    • There are a number of reasons you might make too many tears, common causes include:

      • Something irritating your eye

      • Dry patches on the eye causes the tear gland to flood the eye to try to soothe the its surface

  • Your tear duct/drain may be blocked

    • This is like the a clog in the drain of your sink

    • It is a common cause of tearing and generally requires surgery to fix

  • Your lids may not be pumping your tears into your tear duct.  

    • Unlike a sink, our bodies also have a ‘tear pump’ - our lids 

    • When we blink, our eyelids push tears across the eye to the area of the tear duct 

    • In some patients, the lids become so loose that the tears never make it to the tear duct, leading tears to spill over onto the cheek.


Will I need any testing?


If you suffer from excessive tearing (epiphora), Dr. Repp will need to determine which of the main causes of tearing is responsible for your symptoms.   Dr. Repp may flush your tear duct in the office to determine if you have a blocked tear duct.  Flushing your tear duct will tell Dr. Repp whether you will benefit from tear-duct surgery (DCR), but simply flushing the duct cannot fix the blockage – that requires surgery in most cases.  


How does surgery work and what can I expect the day of surgery?


Surgery for a blocked tear duct requires detouring your tears around the blockage in the tear duct.  Many patients wonder if the blockage can be removed or if the duct can be “stretched” back open.  Unfortunately, these strategies frequently fail to fix the problem.   


Surgery for a blocked tear duct is typically an outpatient, or day surgery, allowing you to recover at home following surgery.  


Tear duct surgeries are commonly done in an ambulatory surgery center.  Dr. Repp will work with you to customize a plan to help keep you comfortable during surgery.  Most patients receive medication to help maintain general comfort during the procedure (IV sedation).  They will also get medication to anesthetize the area around the tear duct.  


Commonly, Dr. Repp will make a small incision between the corner of the eye and the side of the nose to get to the tear duct.  After exposing the tear duct, you surgeon can bypass or ‘detour’ your tears around the blockage so your tears enter the nose.  Dr. Repp will place some sutures in the skin and may also place a small, silicone stent into the tear duct to prevent the new opening in your tear duct from closing.    Patients commonly wonder if this tiny silicone stent or “string” is a “drainage tube.”  The little string doesn’t drain tears and it isn’t permanent.  If you surgeon places a silicone stent, it will come out after the initial period healing is complete.  


After surgery, most patients will return home the same day for recovery.   


What about recovery and aftercare?


Each patient is unique, so Dr. Repp will customize an after-care plan for you, but some general guidelines follow.  Ask Dr. Repp if these apply to you before following any of the recommendations on this site.  And if something does not seem right, do not hesitate to call Dr. Repp.


Most patients will use frequent cool compresses for the first two days after surgery.  During this time, Dr. Repp will likely ask you to limit activity, commonly recommending that you avoid any heavy lifting or bending.  These activities can stress your surgery site and set back your healing.  Following surgery, most patients experience only mild-to-moderate discomfort that can often be effectively treated at home with medications recommended by Dr. Repp.  If you experience more than mild pain or discomfort, you should call Dr. Repp immediately for recommendations.  You will also need regular ointment on your incision line.  The ointment acts as a salve, soothing the incision as it heals.  


Many patients wonder when they can safely return to work or other normal activities.  There is no single answer for every patient, so ask Dr. Repp for details.  Lastly, Dr. Repp will place sutures during your surgery.  Typically, these are removed between one-to-two weeks following surgery.  Ask Dr. Repp for details.  

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