Lacrimal system or the lacrimal apparatus is a very crucial component of the ocular system. Our eyes can function properly only if the lacrimal system does its job perfectly. The two main functions that a lacrimal system performs are; production of tears for the lubrication of the eyes and elimination of foreign debris to keep the eyes clean and free from any infections. There are glands in the lacrimal system, which manufacture the tears. If the lacrimal system gets obstructed or if there is any other problem in it, the health of the eyes can be compromised. Whenever we blink the tear glands produces tears in small quantities and the insides of the eyelids help in spreading them over the entire surface of the eyes. This keeps the eyes lubricated and prevent drying of the eyes due to exposure to environment. The nose acts as an outlet drain for the excess of the tears. The lacrimal system can be affected by various problems. Some of the most common problems of the lacrimal system are:-

  • Watering of the eyes or teary eyes: – As the tear drain is required for the excess tears to flush out, if there is a blockage in the nose, the tears move back to the eyes. This causes the eyes to water. A blocked tear duct can cause a similar problem and may cause the tears to become infected also. This condition can often occur as a side effect of an eye surgery.
  • Complete blockage of tear ducts/ lacrimal duct obstruction: – In most cases, a complete lacrimal duct obstruction is a congenital defect which can affect one or the both eyes. But, it heals on its own. Though in few cases it may call for surgical obstruction.
  • Dry eye surface: – Sometimes there can be a burning sensation in the eyes which may be caused due to excessive drying of the white portion of the eyes. This can happen when enough tears are not being produced by the tear glands.
  • Cancer of the lacrimal system: – The lacrimal system may develop tumours which may cause the eyelids to become abnormally swollen. Most tumours of the eyes are benign therefore if they are detected in time they can be treated completely.

Surgery of the lacrimal system:-

Lacrimal system surgery is a sub- specialty of ophthalmology and it deals with the problems of the lacrimal system or the tear ducts. Ophthalmology is a general discipline and some particular disorders of the tear duct system can only be treated by lacrimal surgery specialists.

The medical term for lacrimal surgery is DCR or Dacryocystorhinostomy. A DCR is carried out whenever there is any obstruction between the nose and the tear glands. The lining of the nose and the tear sac are joined together to create a drain for the tears to flush out. The fundamental procedure is the same in all cases and it involves insertion of a plastic tube from the eye through to the nose. There are two things that the tube does. It serves as stent in the tear drainage system and it also prevents scarring. The tube is general removed after a few months. The stitches are soluble and therefore there is no visible scar of the surgery. The patient is generally given general anaesthesia before the procedure.

DCR can be of two types; direct or eternal DCR and endoscopic DCR. Each approach has its own advantages and disadvantages. A direct approach for DCR enables the surgeon to assess the situation and makes problems like tumours, lacrimal stones completely visible. The disadvantage of external DCR approach is that there is a residual visible scar.

The problem of visible scar is not with the endoscopic DCR approach. The endoscopic surgical approach can help in keeping the integrity of the lacrimal pump system and the lacrimal sac mucosa intact. The patient can be either partially or completely sedated before undergoing the procedure. Nasolacrimal duct obstruction is an acquired condition which can cause the infection of the lacrimal sac. This can be very effectively treated by endoscopic DCR. Endoscopic approach in DCR is also preferred to correct injuries of the lacrimal system which are often caused by the surgery of the sinus.

Both types of DCR are invasive and any invasive procedure definitely carries some risks with it. In DCR, the most common risk is that of infection. But a patient can avoid infection by following all post- surgical instructions of the surgeon. Sometimes, if the problem is not correct in one procedure an additional surgery may be required. The lacrimal system is very delicate therefore a skilled specialist should only handle any complication in the lacrimal system. Lacrimal system is very important for the well-being of the eyes and any mistake in the surgery can be potentially hazardous towards the health of the eyes.


About Dr. Debraj Shome

Debraj Shome-2
Debraj Shome, MD, DO, DNB, FRCS (Glasgow), FICO (USA), MNAMS, MBA (Healthcare Management, Vanderbilt University, USA), is Consultant Facial Plastic Surgeon, Oculoplastic Surgeon & Cosmetic Surgeon at Nova Specialty Surgery, Mumbai, India..Read more

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