Background/Anatomy: Tear film is essential to the health and integrity of the ocular surface. The aqueous component of the tear film is produced by the lacrimal gland (A). The tears dissipate from the ocular surface by evaporation or by flow through the tear drainage system depicted on the inner aspect of the eyelids (right).
Tear outflow system. The Punctum, (B) , is the opening on the eyelid ( upper and lower lid). Tears then pass through a tear canal (canaliculus) in the upper and lower lid (C), into the tear sac(D), down the tear (nasolacrimal) duct (E), then finally into the nose. Any obstruction along the tear drainage pathway may result in tearing or infection.
Common Conditions and Surgical Repair. An operation bypassing a blocked tear duct, termed Dacryocystorhinostomy (abbreviated as DCR, creates a new passage from the tear sac directly into the nose ( F).
Punctal Stenosis is narrowing of the punctum (B). This may prevent tears from entering the normal drainage pathway. This can be addressed through a small snip incision to enlarge the punctum termed, Punctoplasty.
Dacryocystitis: Blockage of the tear duct results in stagnation of the tears in the tear sac, and the potential for infection in the tear sac shown below. This is typically treated with oral antibiotics or in advanced cases, like that shown below, surgical drainage. A dacryocystorhinostomy (DCR) described above can prevent an infection from reoccurring and solve chronic tearing.