Surgery of Lacrimal Apparatus

How is lacrimal apparatus surgery performed?


The lacrimal apparatus consists of an almond-shaped lacrimal gland and ducts. They secrete the produced proteins and electrolytes by the gland finally leading water to flow by osmosis on the surface of the eye to keep it moist. 

Depending on the anatomical abnormality, there are surgeries involved to resolve the same. They are described in brief as below:

Dacryocystorhinostomy (DCR):

It is a surgery performed if the tear duct of the affected individual is blocked. The surgery creates a new tear duct between the nose and the eyes.

The potential causes of having a blocked tear duct could be as follows:

  • Conjunctivitis

  • Chronic nasal infections

  • Trauma or injury to the nose

  • Nose polyps

  • Obstruction due to a tumor

  • An anatomical abnormality that one may be born with

The surgery is considered when the patient is suffering from symptoms such as irritation of the eye, swelling and tenderness around the eye, and chronic mucus discharge. 

The exact procedure adopted for a DCR depends on the cause of the tear duct being blocked. It is usually performed by an ophthalmic plastic surgeon.

The surgery may be performed under general or local anesthesia. As the nose is involved in the surgery, the surgeon packs the nose with packing material soaked in anesthetic drugs. 

A small incision is made below the eye towards the nose. The underlying tissue is exposed and a small hole is made in the bone below. The hole in the new passageway from the lacrimal sac to the nose. Sometimes the doctor may place a stent to ensure this passage does not collapse over a period. The incision is then stitched together. 

Canaliculi Dacryocyst Ostomy:

This is a surgical protocol used when the tear duct is blocked at birth (congenital condition). The segment where there is a block is cut out and this open end is then joined to the lacrimal sac.

Canaliculotomy:

In Canaliculotomy, an incision is made on the nose. The bone located between the tear sac and the nose is removed. The lining of the tear sac and the nose are attached together to create drainage for the tears.

The incisions are then sutured. The stitches are removed roughly after a week of the procedure. The scar from the procedure settles gradually over a couple of months. 

In cases where the patient does not want visible scarring, the surgeon inserts a stent (clear glass or plastic tube) to facilitate drainage of tears from the inner corner of the eye to the nose. The tube is removed after two months of the procedure. 

Dacryoadenectomy:

Dacryoadenectomy is the surgical removal of the lacrimal gland. 

Dacryocystectomy: 

Dacryocystectomy involves the surgical removal of a portion of the lacrimal sac.

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