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  • Chris Thiagarajah MD

So you're tearing: A Guide for Patients with Treatments.



Tearing is annoying. It can be extremely frustrating and even block your vision. For patients seeking treatment of tearing in Denver there are a multitude of causes and treatments. So why do we tear? It is a complicated but simple system that controls flow of tears from your eye.

Dry Eye

Complete Block of the tear duct

Partial Block of the tear ducts

Functional Block of the tear duct

Canalicular Block

Tear Pump Failure

The most common cause of tearing is in fact dry eye. Though it is counterintuitive, if the eye is dry it is generally irritated. Just like getting a piece of sand in your eye, a dry eye will tear. Treatment for this is often aimed at the dry eye. This involves lubricating the eye, plugging the tear ducts or in rare cases surgery to narrow the aperture of the eye. This is something your eye doctor can treat.

A complete block of the tear duct means that the drain that allows water to exit the surface of your eye (two holes on the eyelid near the nose mark the entrance) are blocked. Water can't exit. Like a sink with a blocked drain, the water overflows. The treatment for a complete block of the tear duct is a dacryocystorhinostomy or tear duct bypass. This can be done through the eyelid or through the nose. It is a real surgery and has a recovery of about one week

A partial block of the tear duct means just that, the drain of the tear duct is partially blocked. As a result patients tear intermittently. They may have worse symptoms when the eye is irritated such as in dry air, windy days or if something is in the eye. Partial blocks of the tear duct can be treated with a dacryocystorhinostomy or stenting of the tear duct.

Functional block of the tear ducts are when tears don't go down the drain but when the doctor tests you in the office it seems as though the water is pass through the tear duct system. This is often treated with stenting of the tear duct. Sometimes a tear duct bypass is needed if the stenting fails.

A canalicular block is when the narrow tubes entering the tear drain are damaged. This can sometimes be opened but often cannot. A Jones tube can be placed which is a glass tube that bypasses the tear duct system. It is not as effective as the natural system and has a lower success or happiness rate.

A Tear pump failure exists when water on the surface of the eye cannot be "pumped" into the tear duct hole. This is often hard to treat. Occasionally, eyelid tightening procedures can help but the real problem here is not blockage of the tear duct but a nerve problem with the eyelid. This can be seen in patients with strokes, floppy eyelid syndrome or old age.

The treatment of tear duct blockages fall into two categories:

DCR - Dacryocystorhinostomy

This procedure is done to bypass the tear duct drain. It is a surgery with anesthesia where a hole is made inside the tear duct for tears to exit. A stent is placed for three months roughly. This is done for complete tear ducts, infected tear ducts, and patients who have failed stenting for functional blocks and partial blocks.

Stenting

This procedure is when a stent is placed in the tear duct. No cutting is made. The stent is left for three months. This procedure is done for partial and functional blocks.

Hopefully this is a good summary of the options for tear duct blockages. If you are tearing and need a consultation call us at 303 468 8844.


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