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Naso Lacrimal Duct Obstruction

The nasolacrimal duct (sometimes called tear duct) carries tears from the lacrimal sac into the nasal cavity. Excess tears flow through nasolacrimal duct which drains into the inferior nasal meatus. This is the reason the nose starts to run when a person is crying or has watery eyes from an allergy, and why one can sometimes taste eye drops.

Like the lacrimal sac, the duct is lined by stratified columnar epithelium containing mucus-secreting goblet cells, and is surrounded by connective tissue.

Obstruction of the nasolacrimal duct leads to the excess overflow of tears called epiphora. A congenital obstruction can cause cystic expansion of the duct and is called a dacrocystocele or Timo cyst. Persons with dry eye conditions can be fitted with punctal plugs that seal the ducts to limit the amount of fluid drainage and retain moisture.

The canal containing the nasolacrimal duct is called the nasolacrimal canal.  If the canal cannot be opened by flushing it out with saline, you may need a more invasive procedure performed called a Dacryocsysticrhinostomy (DCR)

What is DCR surgery?

A DCR is the surgical creation of an opening between the lacrimal sac and the nasal cavity to form a new drainage channel for tears.

In the DCR procedure, the tear drainage pathways are reconnected to the inside of the nose. A small incision is made at the side of the nose, and the lacrimal sac is located, incised and then connected to the nasal mucosa creating a new tear drainage pathway. A tiny plastic tube (Jones tube) is then placed in the newly created tear drainage pathway to prevent scarring of the tear drainage duct, which might otherwise result in failure of the surgery.