Dr. Humbert Massegur explains what endoscopic tear duct surgery consists of. Tears are produced by the lacrimal gland, located in the supero-external part of the eye, and are drained through the superior and inferior lacrimal canaliculi, located in the internal corner of the eye into the lacrimal sac and ducts to the lower part of the nostrils, in the area called the inferior meatus. Most of the tear duct is located in the nostril. That is why nasal endoscopic surgery has as an additional indication the surgery of obstructive problems of this pathway.
The obstruction of the canaliculi must be treated externally, from the eye, but obstructions inferior to the lacrimal sac can be treated from the nose, with a simpler (and more logical) access than through the external route.
- The causes of nasal obstruction can be congenital, very frequent in newborns, or acquired, due to repeated infections or inflammations that produce a narrowing or closure of the lachrymal canal.
- The symptoms produced by the obstruction are constant tearing that may increase on windy days or when looking at the eyes to read or watch television, which darkens the patient’s quality of life. As the tear flow cannot circulate properly and is not drained, there is a greater tendency to infections,
- The diagnosis is, of course, the responsibility of the ophthalmologist, by probing, washing or instillation of colored substances that will serve as tracers. In some cases, radiological explorations with contrast (dacryocystography) and/or CT are performed. For all these reasons there is a tendency for collaboration between the specialties involved for a better diagnosis and to obtain optimal therapeutic results.
- The treatment of obstructions in children tends to be conservative. In adolescents and adults a surgical intervention is required to reopen the tear duct to the nostril called DACRIOCYSTORINOSTOMY (dacryo= tear, cysto= pouch, rhino= nose, ostomy= mouth or opening), i.e. a new drainage orifice is made from the tear sac to the nostril.
What does the operation consist of?
The operation is performed under endoscopic control, through the nostril, using appropriate instruments (gouges, burs, rasps) according to the surgeon’s preference, or laser fiber. The best results are obtained with the classic instrumentation. The laser has specific indications and its results are less spectacular than with the other methods. The external route, preferably used by experts in Ophthalmology, obtains the same results in the short and long term as the endoscopic route, but the latter has been gaining ground in recent years. To ensure the permeability of the newly created orifice, a thin silicone probe is usually used, inserted in both tear ducts and knotted in the nostril, for a variable period of time, although it is not always necessary to leave it in place.
What are the complications?
Complications of the operation are rare, the most frequent being postoperative nasal bleeding, which is easily controlled with an endoscopic exploration and treatment once the bleeding point has been located. Palpebral hematomas, of no importance, may occur in some cases. Extrusion of the probe in the medium and long term is a minor complication, more annoying than serious, although caution must be taken to avoid corneal injury if it is not resolved by repositioning the probe or extracting it through the nose.