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Lacrimal (Tear Duct) Surgery

Oculofacial plastic surgeons are uniquely trained to surgically correct problems with the lacrimal (tear drainage) system. When the nasolacrimal duct (the tear duct that drains the tears from your eyes into the nose) or punctum (the opening into the tear duct) is narrowed or completely closed, it can cause symptoms ranging from bothersome persistent tearing to infections of the nasolacrimal sac (dacryocystitis).

  • Signs and symptoms of a blocked tear duct may include:
  • Crusting of the eyelids
  • Excessive tearing
  • Redness of the white part of the eye
  • Recurrent eye infection or inflammation (pink eye)
  • Painful swelling near the outside corner of the eye towards the nose
  • Mucus or pus discharge from the lids and surface of the eye
  • Blurred vision
  • Dacryocystits (infections of the tear sac)

If you have any of these types of symptoms, or your eye doctor believes you have a blocked or closed tear duct, it is important to see an oculofacial plastic surgeon to determine the next steps. Your eye doctor may provide a referral, or you can reach out to the tear duct surgeons at Wolfe Eye Clinic to request an appointment here.  At Wolfe Eye Clinic, Dr. Douglas Casady and Dr. Audrey Ko are ophthalmologists who have undergone additional fellowship training to treat patients in need of tear duct surgery as well as other oculofacial procedures including eyelid surgery, facial reconstruction and cosmetic surgeries.

There are many reasons that cause the nasolacrimal duct or its opening to become very narrow or completely close. Oftentimes patients with chronic inflammation around the eyes from ocular rosacea, blepharitis, or glaucoma drop use will have a stenosed punctum or narrowed tear duct. Other common reasons the puncta or nasolacrimal duct can close or become narrow include chemotherapy, radiation, or previous injury to that area. The oculofacial surgeons at Wolfe Eye Clinic are experts in helping patients overcome symptoms of tearing related to the nasolacrimal system.   

Punctum Surgery

Punctoplasty: Surgery to open the entrance of a tear duct.

The punctum is a small circular opening located towards the nose on the upper and lower eyelids that serves as the entrance into the tear duct.  A punctoplasty is a type of punctum surgery where this hole is opened or enlarged to allow for tears to drain normally again into the nose. This type of surgery is common for patients who use glaucoma eyedrops, have chronic blepharitis or inflammation around the eye, or have undergone chemotherapy or radiation. These patients often have narrowing or complete closure of the punctum, which blocks the entry of tears into the nasolacrimal duct (tear duct). A punctoplasty restores normal flow of tears into the tear duct. 

Closure of Punctum: Surgery to close the entrance of a tear duct

The punctum is a small circular opening located towards the nose on the upper and lower eyelids that serves as the entrance into the tear duct. In patients who have dry eyes, closure of the punctum by the placement of tiny punctal plugs (commonly used by the cornea specialists at Wolfe Eye Clinic) can increase the amount of tears available to lubricate the eye by preventing their drainage. Closure of the punctum by heat or sutures is a permanent alternative to punctal plugs, which may be preferred by patients whose punctal plugs keep falling out or have irritation from the plugs.

Canalicular Trauma & Surgery

Trauma to the eyelids can damage the canaliculus, which is the portion of the tear duct that runs through the eyelid before entering the nose.  In canalicular trauma, oftentimes the eyelid is also damaged and has a full or partial thickness laceration which requires repair. It is important for the normal anatomy of the tear duct and eyelid to be restored so that the lacrimal pump drainage system, which is responsible for draining tears into the nose, functions normally. If not repaired, patients experience lifelong tearing and irritation of the eyes.

Many types of trauma to the face may result in damage to the tear drainage system, the most common of which are dog bites.  Dog bites usually result in damage to the tear drainage system located on the upper or lower eyelids. When this occurs, repair and stenting of the damaged canaliculus is recommended within one week of injury to prevent irreversible scarring and lifelong tearing.

Canalicular trauma repair is best performed by an oculofacial plastic surgeon who is experienced in the repair of canalicular lacerations. Members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), such as Dr. Douglas Casady and Dr. Audrey Ko, are qualified to perform complex repair of the lacrimal drainage system in Iowa.

Nasolacrimal Duct (Tear Duct) Surgery

When the nasolacrimal duct (the tube that drains tears into the nose) is blocked, a surgical procedure called dacryocystorhinostomy (DCR) is required to open it. During this procedure, a bypass drainage system is created between the nasolacrimal sac (tear sac) and the inside of the nose. This surgery can be performed using an endoscope through the nose without an external incision (endoscopic DCR), or through an external incision in the area where the nose pads of the glasses sit (external DCR).

It is important to choose a fellowship trained oculofacial surgeon to consult with on your options for tear duct surgery. The specialists at Wolfe Eye Clinic are here to answer your questions and help provide guidance on the best outcome for you and your vision. Dr. Douglas Casady and Dr. Audrey Ko are board-certified ophthalmologists with specialized training in oculofacial surgical procedures for the tear ducts and their surrounding structures. Wolfe Eye Clinic is proud to provide oculofacial services to Iowans with two surgeons of just six in the state with this type of specialized training.

Find a Tear Duct Specialist in Iowa

Wolfe Eye Clinic offers tear duct specialists in Iowa who are here to answer any questions you may have. Our fellowship trained oculoplastic surgeons, Dr. Douglas Casady and Dr. Audrey Ko are dedicated to maintaining the functionality of the eyes and offer consultations at our Ames, Cedar Falls, Des Moines, Fort Dodge, Marshalltown and Ottumwa clinics. The oculofacial surgeons at Wolfe Eye clinic can help assess the needs for your tear duct condition at a clinic consultation and consult with cornea specialists if needed. To request an appointment, fill out our form here or give us a call at (833) 474-5850.