Lubrication of the eyes is a very important aspect of proper functioning of the eyes. The lacrimal glands are located in the external orbit of the eye and the secretions from these glands form a protective layer over the eye and also wash it frequently by draining the excess tears via the nasal tube. Tears are vital to keep the eyes in good health.
It is crucial that if a person is suffering from persistent redness of the eyes, blurred vision, continuous burning sensation of the eyes, an ophthalmologist should be consulted immediately. Also, if a person is experiencing dryness in the eyes, this could be a sign of eye infection. Blockage in the lacrimal system or disorders of the eyelids could be behind blurred or double vision. The blockage of the lacrimal system is also known as Dacryocystitis. Lacrimal surgery is a sub specialty of ophthalmology which deals with excessive watering and blockages of the lacrimal system.
Patient with constantly watering eyes are referred to oculoplastic surgeons. Surgeons who perform specialized surgeries like that of lacrimal system are specially qualified to perform surgeries for eyelid disorders like entropion, ectropian etc.
Dacryocystorhinostomy (DCR) or Lacrimal Surgery:-
The treatment plan includes lacrimal probing procedures along with a series of tests, before the actual surgery is performed. The procedure is either done by inserting an endoscopic instrument nasally or by making an incision externally on the face. In this approach an incision is made between the eye and the nose. In this procedure, the aim is to bypass the obstruction thereby allowing the tears to directly drain from the lacrimal sac in to the nasal cavity. To keep the nasal passage open through the procedure, a nasal tube is placed. Once the procedure is complete, the incision is stitched back. The procedure is highly successful in clearing the nasolacrimal duct. The endoscopic approach involves clearing the blockage of the duct by administering a decongestant to the patient. To numb the nasal space which has to be treated, gauze soaked in anesthesia is inserted. The severity of the obstruction is evaluated by inserting an endoscopic probe in to it. In cases of extreme obstruction, the mucous membrane is excised to gain access to the lacrimal sac. After removing a small section of the lacrimal bone, an incision is made vertically on the lacrimal sac. The incision is made to allow the tears to drain from the lacrimal sac into the nasolacrimal ducts. This entire procedure is done just in one step and there is no external scar. Additional advantage of this procedure is that it takes lesser time as compared to external approach and also the integrity of the lacrimal drainage system is maintained. To alleviate pain, patients are given painkillers like acetaminophen. In cases of patients with recurring blockage a procedure known as conjunctivodacryocystorhinostomy (CDCR) is performed. In the eye socket corner, a Pyrex glass tube is placed, where the lacrimal duct directly opens in to the nasal cavity. The procedure should be performed by specifically trained oculoplastic surgeons. Other procedures to treat lacrimal duct may include probing and Punctoplasty. Punctoplasty involves dilation of small orifices in lower eyelids by a dilator. This procedure is done in patients who suffer from punctual stenosis, to improve the drainage of tears. Punctual stenosis is caused due to narrowing of lacrimal punctum which eventually cause the lacrimal drainage system to obstruct. This obstruction leads to severe watering of the eyes also known as Epiphora. This procedure is performed under anesthesia. In the probe and the tube procedure, the lacrimal duct is dilated by inserting a small tube. The blockage is cleared by this dilation. The tube is removed after three months. This procedure is effective for clearing out small obstructions in lacrimal drainage systems and no incisions are made in this procedure.
In addition to removing the blockages of the lacrimal system, the lacrimal procedures can also help to enhance a person’s look. The surgery often includes procedures to alter the shape of the eyebrows, rectify the position of the eyelids and also invigorate the periocular tissues located in the eyelids. Surgeons who perform lacrimal; surgeries often work in close association with specialists of oncology, dermatology, ENT etc. For cosmetic surgical procedures, oculoplastic surgeons work along with dermatological surgeons to help in the removal of periocular basal cells with techniques like Moh’s micrographic surgery.
Dr. Debraj Shome is one of the highly reputed oculoplastic surgeons in the world. He is currently the Head of the Dept in Noval specialty surgery in India. In addition to specialization in Oculoplasty, Dr.Debraj Shome has done extensive research in the field of retinoblastoma treatmen