Background Information:

What are the other Names for the Procedure?

• Balloon Dacryocystorhinostomy
• Blocked Tear Duct Treatment
• Opening of a Tear (Nasolacrimal) Duct

What is Opening of Tear Duct surgical procedure?

This procedure involves opening of the tear ducts, to allow the tears to drain properly.

What part of the Body does the Procedure involve?

Tear glands and tear ducts are the parts involved in the Opening of Tear Duct procedure.

Why is the Opening of Tear Duct surgical procedure Performed?

Every time a person blinks their eyes, tears are secreted. The tears wash the eyes and are drained out through the tear ducts. These tear ducts drain the secretions from the eye to the inside of the nose.

However, sometimes these tear ducts are blocked. This may be due to a variety of reasons such as:

• Underdeveloped ducts in infants
• Facial injury or trauma
• Tumors and cysts
• Abnormal development of the facial bones
• Eye infections
• Certain medications

Generally, the Opening of Tear Duct procedure is not required for infants; in whom applying massages will help, in most of the cases.

What are some Alternative Choices for the Procedure?

Various medicines and/or massage techniques may be utilized in treating the tear duct blockage. However, surgery is generally the preferred choice for treating blockage, which does not respond to massage.

What are the Recent Advances in the Procedure?

Currently certain developments are being carried out to make the process as less invasive as possible, with a quicker recovery time.

What is the Cost of performing the Opening of Tear Duct surgical procedure?

The cost of Opening of Tear Duct procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.mayoclinic.com/health/blocked-tear-duct/DS01096/DSECTION=treatments%2Dand%2Ddrugs (Accessed on 08/31/2012)

http://www.geteyesmart.org/eyesmart/diseases/blocked-tear-duct-treatment.cfm (Accessed on 08/31/2012)

Prior to Opening of Tear Duct surgical procedure:

How is the Opening of Tear Duct surgical procedure Performed?

There are different ways an Opening of Tear Duct procedure is carried out. It also depends on the age of the patient and severity of the blockage. The methods include:

Conservative method: A conservative method is a non-surgical method used in young infants diagnosed with a tear duct blockage, as well as in adults, who have a blockage due to facial swelling. The method involves a special massage technique. Normally, the physician will demonstrate the technique of how to perform the massage.

Minimally invasive techniques: There are three techniques in this form of treatment.

• Dilation, probing, and irrigation: This technique is used mostly for infants having a congenital block. In this procedure, the puncta (small openings at the corner of the eyes) are dilated using a special instrument. Keeping the puncta dilated, the tear ducts are then flushed and irrigated with a saline solution
• Balloon catheter dilation: In this procedure, a catheter (tube) with a deflated balloon on its tip is threaded through the tear duct in the nose. The balloon is inflated using a pump and then deflated. This is carried out a few times, moving it to different locations along the duct
• Stenting or intubation: In this procedure, a few tiny, polyurethane or silicone tube is threaded through one or both punctal, all the way through the duct, out from the nose. The tubes are left for 1-3 months

Surgery (dacryocystorhinostomy): It involves a reconstruction of the duct, enabling drainage of the tears into the nose. Depending on the type of blockage, the reconstruction may involve connecting the tear duct to the nose through a different system, or reconstructing the entire drainage system (also called conjunctivodacryocystorhinostomy).

Where is the Procedure Performed?

The Opening of Tear Duct procedure can be performed at an out-patient surgical facility, or at the surgical facility in a hospital.

Who Performs the Procedure?

An ophthalmologist or a pediatric surgeon performs the procedure.

How long will the Procedure take?

The procedure will take about 10-30 minutes and maybe more, if a bypass of the duct is performed.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the patient’s medical history to gain a comprehensive knowledge of the medications that are being taken currently
• Some of the medications may increase the patient’s chances of bleeding and hence the physician may recommend them to stop such medications for a period of time before performing the procedure
• Sometimes blood test might be performed to determine if the patient has a bleeding tendency or any other medical conditions that prevent them from undergoing the procedure
• Avoid application of any cosmetic or medical chemicals before the procedure is to commence
• A physician will request your consent for the Opening of Tear Duct procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Opening of Tear Duct procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Opening of Tear Duct surgical procedure?

Before Opening of Tear Duct procedure is performed, the patient may need to have the following tests done, as suggested by the physician:

• Routine blood test
• Routine urine examination

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is an Opening of Tear Duct procedure?
• Why is this procedure necessary?
• What does the procedure involve?
• How will this procedure help?
• Will I need adjunct treatments after the surgery?
• How soon should I get it done? Is it an emergency?
• What are the risks while performing the procedure?
• Are there any complications after the procedure, or during recovery?
• How long will it take to recover? When can I resume normal work
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• How many such procedures have you (the physician) performed?
• What are the costs involved?

During the Opening of Tear Duct surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Prior to the procedure, the patient may be administered local anesthesia by injection, a topical application, or even general anesthesia. A general anesthesia is preferred while operating on children.

How much Blood will you lose, during the Procedure?

There is almost a negligible or minimal amount of blood loss. No blood transfusion is required unless any complications arise.

What are the possible Risks and Complications during the Opening of Tear Duct surgical procedure?

The risks and complications differ depending on the type of surgery being performed. These could include:

• Injury to any other part
• Infection
• Bleeding
• Pain
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Opening of Tear Duct surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Opening of Tear Duct surgical procedure:

What are the possible Risks and Complications after the Opening of Tear Duct surgical procedure?

A few risks and complications after the surgery could include:

• Surgical wound infection
• Recurrent blockage of the duct
• Excessive tears

What is the Prognosis after the Surgery?

After the procedure, a complete healing is expected without any complications.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Any sign of infection
• Swelling, redness, or pain
• Nausea or vomiting
• Fever, headache, or muscle ache

What Post-Operative Care is needed at Home after the Opening of Tear Duct surgical procedure?

At home, the following post-operative care is recommended, after an Opening of Tear Duct procedure:

• Eye drops are to be applied regularly, as prescribed by the physician
• Take medicines regularly, as prescribed
• Avoid vigorous activities for 10 days

How long does it normally take to fully recover, from the Procedure?

It generally takes about 7-10 days to fully recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Opening of Tear Duct surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility
• An ophthalmologist or pediatric surgeon
• An anesthesiologist (if anesthesia was administered)

The patient is advised to inquire and confirm the type of billing, before the procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA