As soon as there is evidence that the lacrimal ducts are narrowed, the focus is on the localization and extent of the constrictions or stenosis.
For this purpose, we perform a lacrimal endoscopy. A micro-camera with a diameter of one millimeter is inserted into the lacrimal canal via the lacrimal dot and then carefully advanced into the nasal cavity. Constrictions in the area of the lacrimal dots or the lacrimal canal can be detected and resolved. To prevent them from regressing, a placeholder is inserted (tear duct intubation with silicone hose) and left for at least two months. The lacrimation persists until the silicone tubes are removed, only then can the tears drain properly again.
If the constrictions are deep in the lacrimal sac, a more complicated procedure is usually necessary. This involves opening the lacrimal sac from the outside (Toti operation) or through the nose (endonasal DCR) and creating a new outflow through the bones. This type of procedure is called dacryocystorhinostomy, usually takes over an hour and is usually performed under general anesthesia and in an inpatient setting.
Local anesthesia is usually sufficient to perform lacrimal endoscopy without pain. The sensitive nerve branches around the outer eye socket are anesthetized with lidocaine.
Dacryocystorhinosthomia (DCR), on the other hand, usually requires general anesthesia.
After a lacrimal endoscopy, only swelling and minor bleeding around the eye can be expected. Injuries to lacrimal spots and lacrimal ducts are less common, as the lacrimal ducts can be made visible using a camera.
Sweating should be avoided as this creates pressure within the nasal cavities, which could push the silicone tube back out through the lacrimal ducts.
The fit of the silicone hose is checked and the patient is informed about the next steps. In order to prevent the formation of new stenosis in the lacrimal ducts, the silicone tubes are not hollow, which means that tears persist even after the operation until the tube is removed.
Using tweezers, the silicone tube is carefully grasped at its end and pulled out. It may happen that, after removal of the tube, the tears and nasal secretions appear slightly reddish. This should not cause concern, the reason is microbleeding in the lacrimal ducts. The tears can now flow freely through the lacrimal ducts into the nasal cavities.
In consultation with your family doctor, you should, if possible, stop taking medications that inhibit blood clotting.
Eye makeup, heavy lifting and physical activity, especially swimming, should be avoided for up to two weeks after surgery.
As a rule, there is only slight swelling and bleeding in the area around the eyes and vision is not impaired. This means that you could return to full work just a few days after the procedure. For occupations involving customer contact, we can give them sick leave until the swelling and bleeding have completely disappeared.
No, a so-called analgosedation (twilight sleep) can only be initiated, i.e. they will not feel much and will be relaxed but still awake. After endoscopy, the lacrimal ducts are rinsed with a water solution and the solution goes into the nose and then into the throat; they should then be able to swallow this solution to prevent it from reaching the lungs.
A hollow tube would not be stable enough to keep the tear ducts open
In case of spontaneous sneezing, please try not to keep your nose open but rather. This allows air to escape through the nostrils and creates less pressure on the silicone tubes.
The procedure can be repeated several times. However, for stenosis deep in the lacrimal sac, a more invasive Toti operation or DCR is often indicated. To do this, we can refer you to our colleagues who perform inpatient operations.
