Typically, a temporary or dissolvable punctal plug is implanted in the lower drainage channel of the eye, which is responsible for most of the eye’s tear drainage. These temporary plugs will usually last a few days to several months. If there is a successful response to the temporary punctal plug, a more permanent punctal plug is implanted or punctual cautery applied.
Punctal plugs come in a few different shapes and sizes, and are no larger than a grain of rice. The plug may be placed in the lower or upper eyelid or both eyelids. Implantation takes only a few seconds in a physician’s office.
Tear Duct Probing, irrigation, intubation
While most cases of tear duct obstructions clear on their own during the first year of life, certain measures can be taken to ensure that the eye is kept clean and free of infection, such as a tear duct massage performed three times a day or antibiotic eye drops to relieve discharge. If an obstruction does not clear up by the time the child is a year old, a minimally invasive procedure using a probe to relieve the obstruction may be used. This procedure involves passing a soft probe through the tear duct and into the nose to open any obstruction within the path. The procedure takes about 10 minutes to perform.
Adults may also benefit from the probing procedure, however some cases may need to be treated with surgery to clear the obstruction of the duct.
With the traditional external form of this surgery, the doctor would make an incision on the side of the nose and create an opening between the tear drainage system and the nose. With the endoscopic approach, this procedure is formed without the skin incision. The surgeon uses an endoscope -a thin, flexible, lighted tube with a microscopic camera on the end. The camera helps the doctor guide other tiny instruments used in the procedure, through the nasal opening to access the tear duct area this way.
A new tear drain opening is then created, providing a fresh route between the eyes and nose avoiding the obstruction. A tiny stent (silicone tube) may be placed in the new tear drain and kept there for several months after the procedure ensuring the duct will remain open. In cases in which the tear drain blockage cannot be cleared, a small drain, known as a Jones tube, may need to be inserted in the area. This offers a permanent solution to keeping the tear duct clear.
Canalicular Reconstruction & Repair
If there is obvious damage, surgery is usually more effective within 48 hours of the injury, once the surrounding tissue swelling has healed. The surgical technique used for canalicular reconstruction and repair will depend on the extent of the patient’s injuries, and may be performed under local or general anesthesia.
Lacrimal Gland Plication
If the lacrimal gland protrudes, the condition is usually a result of inflammatory disease, such as sarcoidosis. Symptoms of lacrimal gland dysfunction may include dry eye syndrome. Plication is a surgery which repositions the lacrimal gland, so that tears will be more effectively produced and swelling/protrusion limited.
Lacrimal Gland Biopsy
An incisional biopsy, which removes a sample of the growth inside the gland, may be performed if it cannot be determined if the tumor is benign or malignant. Following an incisional biopsy, the specimen will be examined by an attending pathologist. If the tumor is found to be malignant or worrisome the entire gland may be removed.