Nasolacrimal duct obstruction surgery is performed to treat excessive tearing caused by blockage of the tear duct, which prevents normal tear drainage. The procedure opens the obstructed duct or reconstructs a new drainage pathway to restore proper tear outflow and reduce ocular discomfort.
Nasolacrimal duct obstruction refers to a blockage within the tear drainage pathway that carries tears from the eye into the nasal cavity. When the duct becomes obstructed, tears cannot drain normally.
The eyes continuously produce tears to stay lubricated. Under normal circumstances, tears enter the puncta at the inner corner of the eyelids, pass through the canaliculi into the lacrimal sac, and finally drain into the nasal cavity through the nasolacrimal duct. When any part of this drainage system becomes blocked, tears accumulate on the surface of the eye, leading to persistent tearing (epiphora), increased discharge, redness, and swelling. In some cases, bacterial growth may result in dacryocystitis, causing pain, swelling, and pus discharge from the inner corner of the eye. These symptoms can significantly affect vision and overall quality of life.
Most commonly seen in newborns, this occurs when the distal end of the nasolacrimal duct—known as the Valve of Hasner—fails to fully open at birth. Many infants improve spontaneously within the first few months of life, although some may require treatment.
The most common type, typically occurring in middle-aged and older adults. It is often associated with age-related degeneration, narrowing, or fibrosis of the nasolacrimal duct and surrounding tissues.
Chronic conjunctivitis, dacryocystitis, sinusitis, and other infections or inflammatory conditions may cause swelling or scarring of the nasolacrimal duct, resulting in obstruction.
Facial fractures—especially nasal or maxillary fractures—and orbital trauma may directly damage the nasolacrimal duct and lead to blockage.
Benign or malignant tumors of the nasal cavity, paranasal sinuses, or lacrimal sac may compress the nasolacrimal duct and cause obstruction.
Complications from nasal or ocular surgeries may result in narrowing or damage to the nasolacrimal duct.
Certain autoimmune diseases, such as granulomatous disorders, may also affect the nasolacrimal duct.
When conservative treatments (such as massage or antibiotic eye drops) are ineffective, or when symptoms persist and are severe, surgical intervention may be considered.
The choice of procedure depends on the location and extent of the obstruction, as well as the patient's age and overall health condition.
To open and clear the tear drainage pathway. This procedure is primarily used for infants and young children with congenital nasolacrimal duct obstruction, and in some cases of mild acquired obstruction.
The surgeon gently inserts a fine probe through the punctum into the lacrimal drainage system, passing through the point of obstruction. The nasolacrimal duct is then irrigated with normal saline to confirm whether the passage is patent.
In infants and young children, the procedure is typically performed under general anesthesia and has a high success rate in resolving congenital obstruction. In adults, the success rate is lower; the procedure is usually done under local anesthesia and is more commonly used for diagnostic purposes or mild obstruction.
To dilate a narrowed or partially obstructed nasolacrimal duct, restoring normal tear drainage.
Under local or general anesthesia, the surgeon inserts a thin catheter equipped with an inflatable balloon into the site of obstruction within the nasolacrimal duct. The balloon is then slowly inflated to expand the narrowed duct, maintained for several minutes, and subsequently deflated and removed. The process may be repeated several times to achieve optimal dilation.
BDC is primarily used for patients with partial obstruction or short-segment narrowing, and is especially suitable for children and young adults. The success rate varies depending on the severity and extent of the obstruction.
A thin silicone stent or tube is placed within the lacrimal drainage system to keep the duct open and prevent postoperative narrowing or re-obstruction. The stent is typically left in place for several weeks to several months and removed once the duct has adequately healed.
Stent or tube insertion is often performed in combination with other procedures such as probing, balloon dacryocystoplasty, or dacryocystorhinostomy (DCR).
The most commonly used type. Made of medical-grade silicone, they are soft and biocompatible. The stent is typically inserted through the punctum, passed through the nasolacrimal duct into the nasal cavity, and secured either within the nasal cavity or at the punctal area to maintain duct patency. The retention period is generally 3–6 months, and may be longer depending on clinical needs.
These stents feature a specialized anchoring design that allows them to remain in place without the need for external sutures or intranasal fixation, reducing patient discomfort.
When the nasolacrimal duct is completely obstructed or when other treatment methods fail, DCR is considered the gold-standard procedure for acquired nasolacrimal duct obstruction. The goal of the surgery is to create a new tear drainage pathway by directly connecting the lacrimal sac to the nasal mucosa, thereby bypassing the blocked nasolacrimal duct.
A traditional surgical approach. An incision is made in the skin near the inner corner of the eye to expose the lacrimal sac and nasal bone. A portion of the nasal bone is removed, and the lacrimal sac is sutured to the nasal mucosa to form a new drainage passage. This method has a high success rate, though it may leave a small external scar.
A minimally invasive approach performed through the nasal cavity using an endoscope. A portion of the nasal bone and lacrimal sac wall is removed to establish a new drainage opening. Advantages include no external scarring and generally faster recovery.
Silicone stents are often placed during DCR to maintain the patency of the newly created opening and prevent postoperative narrowing. They are typically removed 2–6 months after surgery.
One Week Before Surgery:
・Discontinue anticoagulant medications (such as aspirin). Please confirm with your prescribing physician whether temporary discontinuation is appropriate.
・Stop taking all nutritional supplements (such as fish oil, ginkgo, ginseng, and vitamin E).
・Avoid smoking and alcohol from one week before surgery until one month after the procedure.
On the Day of Surgery:
・Please arrive with a clean face and no makeup; remove any eyelash extensions.
・Do not wear any accessories or metal items. If you have piercings, please remove them in advance.
・If you are nearsighted, you may wear contact lenses to the clinic, but they must be removed before surgery. Please bring a storage case, eyeglasses, or sunglasses for use afterward.
・Cold and Warm Compresses: Apply cold compresses during the first 72 hours after surgery to help reduce swelling and bruising, and keep your head elevated as much as possible. Warm compresses may be started after 72 hours to promote circulation and healing.
・Wound Care and Dressing Changes: Keep the incision area clean and dry after returning home, and change dressings as instructed. If skin sutures are present, they are typically removed around 6–10 days postoperatively, depending on wound condition.
・How to Change Dressings: Clean the wound twice daily using sterile cotton swabs dipped in normal saline, dry the area, and then apply the prescribed ointment. When performing cold or warm compresses, place a piece of gauze over the wound to reduce the risk of infection.
・Medication and Eye Hygiene: Use the prescribed eye drops or ointment as directed to prevent infection and support healing.
・Eye Use and Daily Habits: Avoid prolonged use of mobile phones, computers, or looking down for extended periods. Allow your eyes sufficient rest to facilitate recovery.
・Diet and Medications:
- You may take the prescribed pain relievers as needed to ease postoperative discomfort.
- Avoid irritants such as smoking, alcohol, tea, coffee, spicy foods, and dietary supplements (including vitamin E, lingzhi, and traditional herbal medicine).
- A light diet is recommended, along with adequate hydration and increased intake of protein and vitamin C to support wound healing.
・After DCR Surgery: If you undergo DCR surgery, nasal irrigation with normal saline may be recommended to keep the nasal cavity clean.
・Avoid Rubbing the Eyes and Blowing the Nose: Avoid rubbing your eyes or forcefully blowing your nose, as this may interfere with wound healing or cause displacement of the stent.
・Protect the Stent: If a stent has been placed, take care not to pull or remove it on your own. Regular follow-up visits are necessary for the surgeon to evaluate the stent's condition.
・Postoperative Monitoring: Regular follow-up is required to closely monitor wound healing, tear drainage, and any signs of recurrence. The surgeon will remove the stent at an appropriate time.
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