What is tear duct repair surgery?
Tear duct repair surgery is a procedure that restores the tear drainage system following injury or trauma that has disrupted one or more components of the lacrimal system. The tear drainage system is a delicate network of channels that carries tears from the surface of the eye to the nasal cavity, and when any part of this system is damaged, tears can no longer drain normally, leading to persistent overflow tearing and an increased risk of infection.
Prompt repair following injury gives the best chance of restoring long-term drainage function. Delays in treatment allow scar tissue to form within the damaged channels, which can significantly complicate reconstruction and reduce the likelihood of a successful outcome.
Who needs tear duct repair surgery?
Tear duct repair surgery is recommended when a component of the tear drainage system has been disrupted by injury and normal drainage function cannot be restored without surgical intervention. Common indications include:
- Canalicular laceration — a cut or tear involving one or both of the small channels that carry tears from the eyelid drainage openings to the tear sac, most commonly caused by eyelid lacerations near the inner corner of the eye
- Punctal injury — damage to the small drainage openings at the inner corner of the eyelids that prevents tears from entering the drainage system
- Traumatic disruption of the tear sac or nasolacrimal duct following facial fractures or penetrating injuries
- Injury caused by an animal bite near the inner corner of the eye, which frequently involves the canaliculi
- Damage to the lacrimal system following foreign body injury or penetrating trauma to the inner eyelid area
- Chronic tearing or recurrent infection that developed following a prior eyelid or facial injury where tear drainage disruption was not initially recognized or treated
A thorough evaluation with your surgeon will confirm the location and extent of the injury and determine the most appropriate surgical approach for repair.
What should I expect during tear duct repair surgery?
Prior to surgery, you will meet with your oculofacial plastic surgeon for a comprehensive evaluation. During this appointment, your surgeon will:
- Examine the tear drainage openings and surrounding eyelid tissue to assess the extent of the injury
- Probe and irrigate the drainage system to identify which components have been disrupted
- Evaluate the eyelid and surrounding structures for associated injuries that may need to be addressed at the same time
Tear duct repair surgery is performed as an outpatient procedure. Local anesthesia is used in most adults, with general anesthesia used for children or in cases of more complex or extensive injury. When possible, repair is performed as soon as possible following the injury before tissue swelling and early scar formation increase the difficulty of the repair.
The surgical technique depends on which component of the drainage system has been injured:
- Canalicular repair is the most common form of tear duct repair surgery and is required when one or both canaliculi have been lacerated.
- Punctal repair addresses injury to the drainage openings at the inner corner of the eyelids. Depending on the nature and extent of the injury, the punctum may be reconstructed directly or a stent placed to maintain its opening during healing.
- Tear sac and nasolacrimal duct repair is required when trauma has disrupted the tear sac or the duct that connects it to the nasal cavity. In cases where the damage is extensive or where significant scarring has already developed, a dacryocystorhinostomy (DCR) may be performed at the same time or as a secondary procedure once initial healing is complete.
Associated eyelid laceration repair is frequently performed in conjunction with tear duct repair when the injury involved a laceration near the inner corner of the eyelid. The eyelid wound is carefully closed in layers following completion of the drainage system repair.
What should I expect after tear duct repair surgery?
Recovery from tear duct repair surgery is generally well tolerated. Most patients are able to return to light daily activities within a few days, with full healing of the repaired drainage system taking several weeks to months.
In the first several days following surgery, it is normal to experience:
- Swelling and bruising around the inner corner of the eye and eyelid
- Mild discomfort or tightness at the repair site
- Awareness of the silicone tube at the inner corner of the eye, which may be faintly visible
- Temporary tearing or changes in drainage as the repaired system heals
The silicone tube is typically removed between six weeks and three months after surgery. Tearing often improves gradually as healing progresses and the repaired drainage system resumes normal function following tube removal.
What are the risks of tear duct repair surgery?
As with any surgical procedure, there are potential risks to be aware of:
- Failure of the canalicular repair resulting in persistent tearing
- Scarring or closure of the repaired channel during healing despite stenting
- Premature displacement or loss of the silicone tube before healing is complete
- Infection at the repair site
- Granuloma formation around the silicone tube
- Incomplete restoration of drainage function requiring additional surgery such as DCR
- Scarring or irregularity along the eyelid margin if an associated laceration was repaired at the same time
- Recurrent tearing if the repaired channel narrows over time
The oculofacial plastic surgeons at The Iowa Clinic are trained in microsurgical tear duct repair and will evaluate your injury promptly to give you the best chance of restoring normal drainage function. Call 515.875.9480 to schedule an appointment.