The tear drain consists of two small openings called puncta. One punctum is in your upper eyelid and the other punctum is in your lower eyelid. Each of these openings leads into a small tube called the canaliculus which, in turn, empties into the lacrimal sac between the inside corner of your eye and your nose. The lacrimal sac leads into a canal called the nasolacrimal duct that passes through the bony structures surrounding your nose and empties tears into your nasal cavity and down the throat.
When you blink, your eyelids push tears evenly across the eyes to keep them moist and healthy. Blinking also pumps your old tears into the puncta and lacrimal sac where they travel through the tear duct and drain into your nose. If the tear duct is blocked, your tears back up and spill over your eyelids as if you were crying. Tears trapped in the tear sac also can become stagnant and infected. A dacryocystorhinostomy (DCR), blocked tear duct surgery, can be performed to correct this problem.
The most common symptoms of a blocked tear duct are excessive watering, mucous discharge, eye irritation, and painful swelling in the inner corner of your eyelids. A skillful history and physical examination can usually pinpoint the cause of tearing. If your symptoms go untreated, an infection may develop within your tear ducts.
A number of treatments may be available to you based on your symptoms. In some instances, it may be as simple as applying warm compresses and antibiotics. But often, surgery is the most effective treatment.
The most common surgical solution is the dacryocystorhinostomy, or DCR. The procedure has a high success rate (more than 90%) for adults who have not had prior nasal surgery or disease. To perform the procedure, your oculoplastic surgeon will create a new tear drain opening from the lacrimal sac directly into your nose to bypass the obstruction. A small incision is made either in the skin or inside the nose. A fine, soft silicone tube, or stent, may temporarily be left in the new tear drain for between three to six months after surgery to keep the duct open while healing occurs. Then, the tube or stent is removed. You may also have a larger tube placed in the nostril to aid in draining. This tube will fall out on its own in about 3-6 weeks.