INTRODUCTION

Tearing in one or both eyes can be caused by blockage of the tear drainage tract (nasolacrimal duct). The normal tear production that keeps the eye moist simply cannot leave and backs up in the lid opening and runs down the face. To correct that, the surgeon will place a small plastic stent in the tear duct. This will open the duct and at the same time prevent the immediate closure of the duct by scar tissue or swelling. The plastic stent will be removed in the future; days, weeks or months. Because of the manipulation, this operation needs to be done under general anesthesia.

Pre-Operative Evaluation

You will need a note from your/your childâs medical doctor before admission to the hospital. Please bring this with you.

Laboratory work may or may not be needed. This will be done if necessary the day before or the morning of surgery.

Sometime in the afternoon on the day prior to surgery you will be contacted by the hospital. The time of the last feeding prior to surgery will be reviewed. This will depend on the age of the patient and the time of the surgery. The importance of an empty stomach prior to anesthesia will be emphasized. All food and fluid will need to be held after a certain hour.

EXPECTED COURSE

The surgery is done on an out-patient basis under general anesthesia (put to sleep). At the time of surgery it may be necessary to break several small bones inside the nose (turbinates) to allow adequate opening of the tear duct into the nose. The stents will be placed inside the tear duct and secured inside the nose with sutures that dissolve in one to two weeks. It is expected that there will be bleeding from the nose and corner of the eye for one to two days after surgery. Sometimes the lower lid is swollen for one to two days. It is possible that the stents can be pulled out prematurely by the patient. This may or may not compromise the results of the surgery. Matter and discharge from the eye and nose can be carefully wiped away, making sure not to pull out the stents. After the tearing problem clears, the stents can be removed if they have not come out on their own. This step is done easily in the office.

COMPLICATIONS

Rarely it is not possible to open the tear duct or not possible to put the stents in both the upper and lower lids. In those cases the stents may be placed in one lid or even as an outside loop on the nose. Bleeding from the nose can be quite noticeable at times, but is never a major concern from the point of view of blood loss. The most likely problem is premature loss of the stents with the reappearance of the tearing. In rare cases the tearing may not be relieved with this operation even though the stents stay in place an adequate length of time. Further surgery is needed in those cases, perhaps after special testing to see where the obstruction is. As with any operation under general anesthesia, there are always certain unpredictable risks of untoward reactions. These reactions are extremely rare but can be very serious, including death. We and the anesthesiologists will discuss these risks in detail as so desired.

Recovery room

Following surgery the patient is taken to the recovery room where special nurses and equipment are available. Here the recovery from anesthesia is supervised. When a satisfactory state of consciousness returns, the patient is sent to a separate room. The family can rejoin the patient at this time.

POST-OPERATIVE COURSE

Eating: Until the patient is well awake nothing by mouth should be encouraged. Once awake, the patient may have ice chips or small sips of a beverage. Nausea may occur after the administration of anesthesia. Large quantities of food should be avoided in the immediate post-operative period as they can irritate the stomach. Usually the patient is able to resume a regular diet the day following surgery.

Bandages: The incisions in the operated eye(s) will be covered a greasy ointment and possibly a soft dressing under the nostril(s). It is important to try to prevent rubbing. Rubbing can cause the tube to come out.

Tearing: Tearing may occur the first few days after surgery. If it is bothersome, they can be gently wiped away with a tissue or other soft material like a towel.

Pain: Generally there is little or no pain. The eyes may be sensitive to the light due to inflammation. Over the counter medications such as Tylenol or Advil are usually sufficient. Only very rarely are prescription pain killers needed. If severe pain associated with tearing is present, you should contact the surgeon immediately.

Activity: All patients are allowed up with supervision the same day. Infants and small children may be held in the parentsâ arms. Swimming is not permitted for one week. Keep soap and water out of eyes while bathing.

Glasses: The eyes may be light sensitive following surgery. In this case, older patients will appreciate sunglasses or wide-brimmed hats. Younger patients may choose to close their eyes to avoid the light. If glasses are worn before surgery, they will probably be continued immediately after surgery. They may be modified at some time during the post-operative period.

Medications: After tear duct surgery antibiotic eye ointments are required. Antibiotic ointments are used to prevent infection. Additional medications such as eye lubricants may be added to the regimen.