Tear Duct Surgery

tear duct surgery

Punctal 3Snip

There is a small hole at the inner corner of the upper and lower eyelids. These holes are known as puncta. The puncta are one of the structures responsible for collecting tears which then drain away into the nasal passages. If the puncta are too small, tears will be unable to drain out properly. This results in a watery eye. Tears may even spill over onto the cheeks causing soreness and irritation to the skin.

a close view of a light brown eye.

A 3Snip procedure is a minor operation on the lower puncta to make the holes slightly larger. This means tears can drain away more effectively after the operation. Up to three small cuts ('snips') are made into the skin surrounding the puncta, usually on the lower eyelid. Sometimes the surgeon may flush some water through the tear duct to check if the puncta have opened sufficiently. You may feel this in the back of your throat. No stitches are required. You will have a follow-up appointment a few weeks after the procedure to assess if it has been successful. Typically the procedure takes about 10 minutes.

Women in eye clinic getting eye measured
Risks Of Punctal 3Snip

Every surgery comes with risk. Here are some of the very rare risks associated with a punctal 3Snip:

  • Bleeding From The Wound: This Should Settle Within A Few Hours.
  • Bruising & Swelling Of The Eyelids: This Should Settle Within A Few Days.
  • Infection.
  • The Puncta May Scar & Become Small Again, Or Sometimes May Close Completely. You May Need Further Surgery To Correct This.
  • In Some Cases, The Blockage May Be Further Down The Tear Drainage System & This Operation Will Not Resolve The Problem. This May Require A Different Operation; Your Doctor Will Discuss It With You If This Arises.

Dacryocystorhinostomy (DCR)

THE PUNCTUM is the tiny opening at the inner corner of your upper and lower lids.

Once we identify a blockage, we can proceed with surgery to correct the issue. This surgery is called a dacryocystorhinostomy (DCR). Not everyone will have surgery, especially if the symptoms are not that bothersome.

THE CANALICULI are fine horizontal passages that connect both the puncta with the tear sac.

THE TEAR SAC rests at the side of your nose. The sac collects tears and mucous before they pass into the nose.

The sac drains into the nose via the NASOLACRIMAL DUCT. This duct ends deep inside the nose. Normal tearing drains into the nose and down the throat. That is why crying may cause your nose to run.

When Do You Need Surgery?

Not all blocked tear ducts need surgery. People with dry eyes may be unaware that they have a blocked tear duct. An indication that you need surgery is when tearing is bothersome or when infection occurs. Patients who require intraocular surgery, such as cataract surgery, are advised to have tear ducts unblocked to prevent eye infection after intraocular surgery.

DCR Surgery

DCR (dacryocystorhinostomy) bypasses the blockages in the nasolacrimal duct. The tear sac is directly connected to the nasal cavity. The surgery takes about 25 minutes per side. We can administer a general anesthetic or a local anesthetic with intravenous (IV) sedation. Local anesthetic with IV sedation has significant advantages, including less bleeding and quicker recovery times.

With the IV sedation, you will be aware of things happening but will be comfortable. You may not remember the surgery very well afterwards. With a general anesthetic, you will be unconscious throughout the procedure. General anesthesia does carry some higher risks and slower recovery time. Most patients will go home the same day as surgery. The success rate with surgery is about 95%, as with any surgery, there are risks associated with this procedure.

eye surgon focusing lens over patients eye during surgery
Endoscopic Surgery

DCR surgery may be performed endoscopically through the nose. The advantage of this approach is no skin incision. The disadvantage is a general anesthetic is usually needed, and the temporary tubes are left in longer. (Approximately three months vs. three weeks). There is also a slightly lower success rate – 85% with this approach.

Tubes

We may use temporary tubing to keep the new drainage passage open after surgery. The decision to use temporary tubing depends on risk factors for scar formation. Temporary tubes help hold the new passage open. This temporary tubing is removed three weeks to six months after the surgery. This is easily done, like removing a stitch. Tears may not drain properly until we remove the temporary tubing.

Permanent tubes or "Jones Tubes" are tiny glass tubes that can be left in place indefinitely. Jones tubes are used when there is canalicular scarring or repeated failure of the original surgery. Jones tubes can be removed or exchanged if needed. Keep the Jones Tube clear by rinsing with saline every morning. To do this, put a drop of artificial tears into your eye, hold your nose closed and gently sniff in.

Pre-operative Instructions
  • You should not drive to or from your surgery. Bring a friend or relative with you.
  • Blood thinners (ASA, Warfarin, Pradaxa, Xarelto) are usually discontinued one week before surgery – please contact your prescribing doctor to make a specialized plan for you. Other blood thinners such as Vitamin E, Ginko Biloba, ginger, garlic, Advil, Motrin, Naproxen, and green tea need to be discontinued a week before surgery.
  • Do continue taking all of your regular medications, especially blood pressure medications.
  • Please do not wear any eye make-up on the day of your surgery.
  • Make sure that your blood work has been completed at least three weeks before your surgery or as otherwise indicated by the office. Patients who have not completed their blood work could have their surgery cancelled. The blood work requisition is attached to the back of the paperwork. You do not need to fast for these blood tests.
Post-operative Instructions

For post-operative instructions for your dacryocystorhinostomy surgery, please see our page on post-op instructions for tear duct surgeries.

Rescheduling Or Cancelling

If you need to cancel or reschedule your surgery, we need at least one week's notice. If you do not provide one week's notice, there will be a rebooking fee of $100. Exceptions are made for emergencies with supporting documentation. Please call Surgical Booking at 403-245-3171 as soon as you can.

doctor consult woman patient filling medical form at appointment
Probing Of Tear Ducts

Many children are born with small or blocked tear ducts. This can cause tearing from the eye as well as mucus discharge. If the tear duct remains blocked by the age of 10 – 14 months, it is unlikely to open on its own and usually requires a tear duct probing procedure. Sometimes the tear sac will fill up with fluid, and pressure directed over the tear sac may empty it, causing a gush of tears or thick fluid from the punctum. Antibiotics are not routinely prescribed for a blocked tear duct unless there is an associated infection. Your doctor may prescribe antibiotic drops for eye infections and oral antibiotics for deeper tear sac infections.

The Probing Procedure

A tear duct probe takes about 10 minutes, including the general anesthetic and is 90% effective.A small probe is inserted into the punctum and is gently passed through the tear duct into the nose. In many cases, this is all that is needed to open the blockage. If the tear duct is found to be relatively narrow or severely blocked, a tube or "stent" may be inserted to keep this passageway open. Often the structures in the nose will be stretched to improve tear flow. This may cause a small amount of bleeding from the nose for a day or two.

Temporary Silastic Tubes (Crawford Tubes)

These are fine soft tubes that try to prevent the blockage from reforming by holding the duct open. These tubes do not actually drain tears. They will be left in from several weeks to six months. This tubing is threaded through the upper and lower punctum, and the ends are joined together inside the nose. You will be able to see a tiny bit of tube at the inside corner of the eye. The rest of the tube is hidden inside the nose.

Tube Removal

The temporary tubes often fall out on their own. Removal of the tube(s) is usually done in the office at approximately 6-7 months following surgery if it has not fallen out on its own. (Should the tube dislocate prior to this time, please refer to the section at the end of this page entitled "what to do if the tube comes out.") To remove the tube in the office, the surgeon will cut the tubing (where it is visible at the inner corner of the eye) and pull the tube out as though it were a stitch. This is painless and takes only takes a few seconds.

Medical practitioner answering phone calls and scheduling appointments in hospital office.
Pre-operative Instructions
  • The Alberta Children's Hospital's Pre-op Assessment clinic will phone you and advise you of any pre-operative instructions.
  • You will be asked to call the hospital the day before surgery to find out the exact time of surgery. You will be instructed to arrive 2 hours before surgery. You can stay with your child before and after surgery. The hospital will advise you regarding what your child may eat and drink before the surgery.
  • YOU MUST FOLLOW THESE DIRECTIONS EXACTLY. Failure to do so may jeopardize the health of your child and cause the cancellation of surgery. A cancellation fee may apply.
Post-operative Instructions
  • For detailed post-operative instructions for your tear duct probe, please view our post-op page here.

What To Do If The Tube Falls Out?

The tube has to come out eventually. Many children will loosen the tube themselves. If the tube is still in place after six months, it will be removed in the office like a stitch. If the tube comes loose, it will hang out in a loop from the eyelid's inner corner. This is neither dangerous nor an emergency.

To remove the tube, cut the loop with scissors and gently pull on one end. The tube should easily slide out, and you will end up with two small pieces of tubing and one piece of thread with a knot in it. Do not attempt to retrieve the tube through the inside of the nose. The tube can also simply be taped to the side of the nose to secure it and can be removed the following clinic day at the office. The INTACT loop should NOT be tugged on forcefully or pushed back in under any circumstances.

Please book a six-month follow-up appointment with Dr. Ashenhurst ONLY if your child had a tube inserted. Otherwise, please call our office with an update in one month (a follow appointment is unnecessary unless your child is experiencing problems).

Risks Of Surgery

    All surgeries include risk. Risks associated with undergoing general anesthesia include:

  • Strange Heart Rhythms
  • Cardiac Arrest
  • Breathing Problems
  • Allergic Reactions To Medications

If your child is still tearing several months following tear duct probing and irrigation, your child may need a second procedure to insert a tube.

Rescheduling Or Cancelling

If you need to cancel or reschedule your surgery, we need at least one week's notice. If you do not provide one week's notice, there will be a rebooking fee of $100. Exceptions are made for emergencies with supporting documentation. Please call Surgical Booking at 403-245-3171 as soon as you can.

tear duct surgery