For the good health of the eyes, it is imperative that the lacrimal system function properly. The system produces the tears for lubrication of the surface of the eye and also eliminates foreign bodies that may enter the eye. The lacrimal system comprises of glands which produces tears. Any problem in the lacrimal system can be detrimental to the eyes and the vision. Blinking lubricates the eyes with tears that the glands produce and the excess tears drain through the nose. Malfunction of the lacrimal apparatus can cause problems such as:-
What is lacrimal surgery?
Oculoplastic surgery and lacrimal surgery are sub specialties of ophthalmology. Oculoplastic surgery deals with disorders of eyelid whereas lacrimal surgery deals with disorders of the tear duct. The need for the sub specialty rose because some specific disorders of the eyelids and tear ducts are unresponsive to general ophthalmic procedures. Dacryocystorhinostomy is the medical term for lacrimal surgery. This procedure is a simple out patient procedure. The obstruction between the nose and the blockage of the tear sac is cleared by this procedure. A permanent drain is created for the tears by attaching the lining of the tear sac to the lining of the nose. A plastic tube is placed from the inside of the eye in to the nose, in almost all the cases. The tube not only serves the purpose of preventing scarring but also stents the tear drainage system. The tube is removed after six months and anti scarring drugs may be utilized to optimize the result of the surgery. As the sutures dissolve within a week or fortnight the scar becomes smoother and becomes nearly invisible in six months. The procedure is generally carried out under general anesthesia. The DCR procedure can be either performed endoscopically or by making a direct incision. There are many advantages of external DCR. The success rate of external DCR is 90-95%. An external DCR can help in direct visualization of the abnormalities of the lacrimal sac like tumors, foreign bodies, lacrimal stones etc. In external DCR, the lateral nasal mucosal flaps and nasolacrimal duct are directly sutured which helps in healing of the flaps which creates bypass for the system. An external DCR procedure does leave a visible scar, which is a disadvantage. An endoscopic DCR has the advantage because the incision is not visible. An endoscopic DCR can be performed either under local or general anesthesia. In an endoscopic DCR surgery, the lacrimal pump system is preserved. Also, lacrimal sac mucosa is preserved in endoscopic DCR. An endoscopic DCR may be performed if there is lacrimal sac infection which can be associated with nasolacrimal duct obstruction which is acquired. Also, in case where surgeries of the sinus causes lacrimal duct injuries endoscopic DCR is preferred.
The prognosis of both external and endoscopic Dacryocystorhinostomy is very good and is between 90-95%.
Complications and risks associated with the DCR
Both the procedures are safe and relatively simple. But there are always some risks associated with all invasive procedure. The most common risk is infection. But infection can surely be avoided if proper post operative care is taken. Other rare complications may include requirement of a secondary surgery and sinusitis.
Health of lacrimal apparatus is crucial to functioning and good health of the eyes. Whatever approach is used it is imperative only a skilled and reputed surgeon carries out the procedure. Even a small mistake can compromise the health of the eyes of a patient and in some cases even the vision may be affected. Therefore, only a certified and reputed hospital should be chosen.
Any changes in the eyes should be brought to the ophthalmologist’s notice. If a person experiences, redness, burning, excessive itching in the eyes, it could be an indication of a problem in the eyes. Delay in treatment can worsen the problem, and if timely treated all disorders can be completely repaired.