DCR surgery should never be the first line of defense in epiphora treatment. In fact, it should never be the second or third, either. It should be dead last in the list. Only when every other method has been utilized exhaustively should such a drastic procedure be considered, and only then after the patient has been fully informed about the how a DCR is performed and what the risks are. Sparing details here is no different from flat-out lying. A lie by omission is still a lie. Lying to patients about the details of a medical procedure is about as unethical as it gets.
Because it’s difficult to know exactly what is causing the epiphora upon preliminary examination, especially considering it is usually a variety of factors, a number of initial treatments should be used. I barely received two of the following five treatment options. I was given unaggressive syringing early on, and then steroid eye drops. I supplemented this with over-the-counter antibiotic eye drops on my own, although my ophthalmologist didn’t think it was necessary.
Until you have tried everything in this list, don’t even begin to think about having a DCR performed. If your ophthalmologist isn’t willing to try all of these options first, get out of there! These are not unusual or new treatments. They are the status quo for many practices. And what’s more, they are proven effective by multiple studies and tons of clinical experience. If your doctor says otherwise, he or she is simply wrong.
Early Treatments
1. Punctual Irrigation (Dilatation and Syringing)
Punctal dilation is very simple, and is done before syringing or on its own. The process consists of the application of anesthetic, then the insertion of a tapered instrument into the punctum. This will help to stretch it open slightly, potentially clearing any mucus plugs or simply expanding an unnaturally narrowed punctum. It will also allow a larger more defined opening for the insertion of a syringe.
A specialized syringe filled with saline is inserted into the punctum and led down the lacrimal duct. At this point, it may serve as a probe as well (discussed next). It is inserted until it hits the bone, and then retracted slightly. The plunger is then pushed with some force. At this point, any reflux of the fluid back into the eye is noted, indicating at least a partial blockage. The patient is then asked if he or she can feel or taste the saline in his or her nose. If not, then the blockage is usually deemed complete, or further diagnostics are performed. If the patient can feel or taste the saline, there may be no blockage or only partial blockage.
2. Therapeutic Probing
While probing is the status quo for congenital lacrimal obstruction in children, it is not regularly used on general lacrimal obstruction or stenosis in adults. The research and clinical experience, however, point to this as a viable treatment option that is currently under-utilized.
Probing may be used in conjunction with dilation and syringing, usually after dilation. This will allow for the most effective syringing possible, and thus a possible cure or at least temporary relief early on. It can actually serve as a diagnostic and therapeutic technique at the same time.
A small-gauge probe is inserted into the punctum and led into the canaliculus. If it stops hard against the bone, then there is not a complete obstruction, since it has successfully entered the lacrimal sac. If it stops ‘soft’, then there may be a blockage because it is stretching on the duct tissue rather than reaching the end firmly. If this happens, the probe is taken out and reinserted. If it reaches with a hard stop, successively larger probes may be used in order to widen the lacrimal duct and clear and partial obstructions. Syringing is then performed to provide additional clearance and to confirm the clearness of the duct.
Study:
‘Efficacy of probing as treatment of epiphora in adults with blocked nasolacrimal ducts’ (Link)
‘Probing in adults with confirmed nasolacrimal duct obstruction can be recommended as an initial treatment procedure because of its relatively good efficacy and high patient satisfaction without compromising subsequent surgical treatment if unsuccessful.’
Published in: British Journal of Ophthalmology, 1998
3. Antibiotics and Steroid Eye Drops
Steroid drops are used because they will reduce allergic inflammation, a common factor in epiphora. Topical steroids are commonly prescribed for allergic conditions. Anti-itch creams, for instance, are topical steroids. As inflammation and irritation decrease, the tear drainage system has an opportunity to correct itself.
Infection can also contribute to a blocked tear duct. In fact, it’s very common for an already blocked up eye to become infected, exacerbating the tearing. This is because the constant flushing of tears would usually help to keep the eye clean and healthy. But when they are stopped up, they stagnate and become a perfect environment to harbor infection. Antibiotics will help with this, and thus can help many epiphora sufferers.
Restasis, an immunomodulator, is also often used with the steroids. It works by decreasing swelling in the eye, thus allowing for more tear production. But wait—why would we want more tears to cure a watery eye? Well, it’s because dry eye is a common cause of epiphora. Confused? Well, it works like this: As the eye dries out, it causes irritation and swelling in and around the eye, followed by an increased chance of blockage and swelling in the drainage system, since it is not as well lubricated by tear production. In response to the irritation, the eye will want to produce more tears. Since the drainage system is impaired, the tears cannot be taken away quickly enough. Thus, we have a watery eye. By allowing for more consistency in tear production and eliminating periods of dryness and irritation, Restasis can help cure some instances of epiphora, and is often prescribed when steroids fail.
Other Diagnostics
1. Dye Test
A few drops of dye are put into the watery eye to see if it drains down into the nose. If it does, then there is no blockage or a partial blockage. If none is seen in the nose and it drips down the cheek, the blockage is likely complete.
2. X-ray Examination (Macro Dacryocystography)
This x-ray examination involves a painless injection of dye into the punctum, which is then visible in the film. This simple and safe procedure allows doctors to determine the precise nature and location of the blockage.
3. Canalicular Endoscopy
In this procedure, a practitioner uses a microcanalicular endoscope to identify the location of the blockage and what is causing it. This device can take video inside the duct to allow a very precise diagnosis.
Advanced Treatments
1. Balloon Dilatation (Dacryocystoplasty or DCP)
During this simple procedure, a balloon catheter, which looks like a small probe, is inserted into the punctum and into the canaliculus. Then it is inflated to enlarge the duct. At this point, it may be left in briefly or taken out right away. The procedure is sometimes done under a sedative, but general anesthesia is not used in most cases. It is a very quick, simple, safe, painless procedure with a very high success rate.
Study:
‘Non-surgical treatment of epiphora by balloon dacryocystoplasty—the technique’ (Link)
‘Dacryocystoplasty (DCP) was offered as an alternative to patients waiting for dacryocystorhinostomy (DCR) for epiphora. 31 procedures were undertaken with a technical success rate of 93% and a clinical improvement in 89% of these patients. It is concluded that DCP should be the technique of choice in the initial management of epiphora due to stenosis or occlusions of the nasolacrimal ducts before contemplating a DCR.’
Published in: British Journal of Radiology, 1995
2. Stenting (intubation)
Stenting is achieved through the insertion of a small tube into the canaliculus. This tube may be made of a variety of materials, but silicone is generally preferred. This tube will allow the flow of tears in a situation where narrowing or recurring blockage had previous disrupted flow. In some cases this stent is a permanent fixture, with in other it may be removed after a period of months. This is not a perfect solution and comes with its own risk, but it is reversible if necessary, unlike the DCR.
Study:
‘Nasolacrimal stent for epiphora caused by obstruction of the nasolacrimal duct’ (Link)
‘A 71-year-old patient with severe epiphora due to a subtotal obstruction of the nasolacrimal duct was initially treated with balloon dilatation. After failure of this procedure a nasolacrimal stent was placed under fluoroscopic control in an outpatient setting. After stenting there was complete resolution of the epiphora during a follow-up of six months. Outpatient treatment of complete nasolacrimal duct obstruction or obstruction after failure of balloon dilatation with a nasolacrimal stent appears to be a good alternative to surgery.’
Published in: Ned Tijdschr Geneeskd (a Dutch journal), 1997
(To see additional important studies, please read my updated blog post.)
I am about to have my 5th procedure for a blocked L tear duct. The new opthalmologist I am seeing is going to do the balloon dilation. I am getting nervous, but I need relief. I have been dealing with this problem since 2008. I am a 51 year old woman. Any feedback would be appreciated.
Kimberly, were the previous 4 procedures the DCR surgery? If so, the may-be simply over healing quickly and scar tissue is blocking the new opening into the nasal cavity.
There’s no need to worry about the balloon dilatation, in fact, I’d like to know if it succeeds for you. Unfortunately, I haven’t spoken to many people using the alternative techniques for tearing since most patients are ushered into a DCR.
Good luck with the Balloon Dilatation, I’m sure you will be fine.
Hi Kimberly, Can you tell me who did your balloon dilation procedure? I have been looking for a doctor to do this because I do not want to have the DCR surgery. I am willing to travel for a good doctor that does the balloon dilation.
Thank you
6 hours post procedure. Doctor thinks it was a success. Barely any bruising right now, very little swelling, but a bloody nose. I hope this works!!
Good to hear Kimberly. Many others will want to know how the balloon dilatation performed for you. Please do check in again and keep us informed of your progress. You are evidence that the non-invasive techniques for a blocked tear duct can work. I wish you a rapid and lasting healing process. All the best!!
Thank you for posting your blog. I have had a blocked tear ducts for about 9 months. I have history of sinus problems that I’m sure contribute to my problem. First ophthalmologist prescribed steroid drops and suggested compresses, massage and suggested I resolve any sinus issues. Duct cleared for a while, then closed again. He never tried to probe and dilate. Then he performed a three snip. Three snip helped at first, now duct is blocked again. Next ophthalmologist/surgeon dilated and syringed twice and found irrigation did flow through, only that duct opening was closed. She wants to dilate again and do a two snip if needed and will probably suggest DCR if this doesn’t work. I wanted another opinion, third ophthalmologist said he saw infection and swelling that would need to clear before he could irrigate. He suggested seeing an ENT and/or stenting or DCR surgery with second the ophthalmologist/surgeon. He remarked about the amount of scarring/swelling of tear duct. I am concerned about doing another two snip procedure. Any suggestions would be appreciated.
Hi Marsha, have you had a dacryocystogram to locate exactly where the block is? The three snip procedure was done on your punctums, correct? They usually perform that during an endoscopic DCR to maneuver the instruments around. Unless the block is up higher in your canaliculi, I don’t see how the 3 snip procedure will help.
If your blockage is lower and in the nasolacrimal duct, is it a partial or full block? and a dacryocystogram will reveal that for you. Since you felt some saline in your throat during a syringe process, you may only have a partial blockage which makes you a good canditate for balloon dilatation and stenting.
Let us know how you go.
Thanks George. The three snip was done on the left punctum. They did not do a DCR. I had already inquired about the dacryocystogram, but was told it wasn’t needed. I will ask again at my next appt. They did do an MRI without contrast that did not show any tearstones, etc. The doctor attempted to find the blockage by syringing repeatedly and was surprised when she could not find any blockage, but that only the top of the tear duct (upper and lower) appeared to be blocked.
Do you think the scar tissue is from overall inflammation or from the first three snip procedure healing over? I agree that dilatation and/or stenting is the next step. Would the doctor need to snip the duct in order to insert the stent? Thanks again for any and all suggestions.
Marsha, I’m just wondering what type of eye specialists you’re seeing. I cannot see any logical reason for doing a 3 snip procedure on the puncta for epiphora. It serves no purpose and in terms of inflammation, everyone is different. Some people will heal faster and a keyloid scar will form, or proud flesh will grow near the wound. I would demand a dacryocystogram, if they refuse, go and see someone else. It’s your right to be treated properly and second and third opinions are highly recommended when it comes to your delicate eye area.
Snipping the duct to insert the stent? Which duct? the upper duct near the puncta (canaliculus) or the nasolacrimal duct (further down)?. Stents are generally used for blocks in the nasolacrimal duct. They will firstly dilate it with ‘balloon dilatation’ then place a stent in the dilated duct. They don’t snip the nasolacrimal duct.
Hello George,
The ophthalmologist did snip open the puncta on my left eye tear duct last summer since it was completely closed and did probe and syringe it successfully. That worked for a few months but now I am still having tear duct issues again in my left eye. I have been using antibiotic and steroid drops, hot compresses which seemed to help several years ago but now they aren’t helping.
Two months ago at my last dr. visit she could not open and irrigate the tear duct as she could during past visits. She suggested I consider bicanalicular silicone tubing intubation. Are you familiar with this procedure? She said it has s 60% success rate. It’s less invasive and the tubes would be removed in 6 weeks to 2 1/2 months. I would like to try it since my eye is irritated by the tears pooling in the corner and my drops and compresses aren’t helping. I wonder if the tube would be bothersome and irritate the inside corner of my eye. I appreciate any thoughts you my have. Thanks, Marsha
Hi Marsha,
The bicanicular intubation is similar to what they use after DCR surgery to keep the newly formed osteum patent (it keeps the new hole they drill into your nasal cavity open, and prevents it from scarring over). However, it’s always removed after a few weeks or months depending on the surgeon. In your case, is your ophthalmologist considering permanently leaving the tubing in place? It certainly can be irritating and I recall looking forward to mine being removed. However, the intubation would be different for you since it wouldn’t (and can’t) be woven around an artificial nasal opening. So it might feel more comfortable.
I asked my surgeon to reverse my DCR after the myriad of complications such as air regurgitation. He said the only way he could do that was to “put back what was taken out”, and his proposed solution was “bicanicular intubation”. It would be a permanent fixture. I couldn’t imagine having that irritating thing in the corner of my eye permanently. Again, it maybe different for you.
Definitely give it a go, it’s safe and can always be removed if you can’t tolerate it. If you decide to go ahead with it, please keep us informed. Good luck!
I have just had a dcr on my right eye and I have to say I am VERY happy with the result. I had very little swelling and a slight bruise and NO PAIN post op. I can tell that I will have no visible scar once it heals completely. I have had severe problems with both eyes for over two years and have had several bad infections on both sides, resulting in swelling and pain. I am due to have the left eye done soon and I have no worries about the surgery whatsoever. I had excellent care and cannot praise my local hospital eye clinic enough.
Hi Diva, sorry for the late response, I’ve been interstate seeing an ophthalmologist. It’s good to hear success stories with DCR. As long as it’s performed for the correct reasons. Having said that, I am absolutely against the surgery since less invasive in-office procedures can erradicate epiphora without drilling through bone and massacring your tear sac.
When did you have the procedure? If only recently it’s too early to say you won’t have complications once the bi-canicular tubing is removed. Often complications occur months later.
Too many ECP’s jump into performing DCR, when it could be possible ‘reflex tearing’ from dry eye. In that case, DCR is absolutely not the correct procedure. Furthermore, before considering surgery, one would expect further testing than simply “syringing of saline” into the puncta. Every ECP should be doing a macrodacryocystogram to locate the a possible block. If it’s at the end of the nasolacrimal duct and very thin…simply probing could unblock it. What about doing a schirmer’s test on the ‘other’ eye to make sure it’s not dry eye and simply reflex tearing?
I’m sorry but the industry with how they approach DCR is significantly flawed. This is a site to warn people about DCR and have them check into it further. I wish you all the best in your recovery.
Thanks to all for the great information that has been so informative and
enlightening.
Will not be having the DCR — this only procedure suggested.
All took the time to be specific and detailed — what a plus — again THANK YOU
I recently Had a DCR. My surgeon decided togo endonasal, then in the middle of the surgery went externally because,he said, I bled a lot and my nose is ” built such a way” After one month, removal of the stent, syringing,I could feel the water inmy throat, went home then my eye started tearing again for the week after stent removal.
Went back to the doctor.Complete blockage of the duct.I cried and cried.He suggested another surgery. Really? Reopen the wound ? Nightmarish !!!! As patients and humans it is apalling how we can be treatted by doctors. They rushed me to surgery without investigating,imaging or anything to localise the blocage. I am in absolute despair and I think everybody should be warned against being pushed into surgery and there must be more protection for patients against doctors whose only interest i to make money. My doctor did not even show the slightest empathy as I was crying out of despair.For your information, Ilive in Vancouver and I had my surgery in Vancouver General hospital.And thank you for this site.I wish I read it before I went for a surgery that turned to be a complete disaster.
Good for you Savina because my DCR surgey did not solve any problem.My tearing never stopped. I am left with a big scar,pain and worse epiphora. Do you think my surgeon did not do a good job?
How long after the stent was removed did it stop wateri g? I have been 3 weeks still waters
Hi Vicki, sorry for the late reply. I was alerted recently to 6 questions I had missed.
When the tubing is removed it shouldn’t water. Give it some time, maybe two months. If it’s still watering them the surgery was a failure. They will usually always recommend having another DCR.
I have had a blocked tear duct for 1 week. I saw an ophthalmologist today and they attempted dilatation and syringing with no success. Therefore, they scheduled me for DCR next week. What should I pursue as an alternative to DCR? Or timeline for waiting for the duct to heal on it’s own? I had a blocked duct 4 years ago that healed on it’s own without any medical treatment within a month.
Hi Rob,
Yes the usual “cookie cutter” style of diagnosis. Absolutely unacceptable. Syringing is not strong enough to push a block through and when you don’t feel the saline in your throat and regurgitation of the saline is pushed back out through the puncta (usually the upper), they refer you to DCR surgery. No further investigations, no time to allow a block to ‘unblock’ naturally with steroid drops, hot compresses, no macrodacrocystogram to locate exactly where the block is, no checks to rule out ‘reflex tearing’ caused by dry eyes.
What if the block is so thin, and located at the distal end…it may-be an indication that simple “probing” could eliminate the problem. But no, it’s off to a dangerous surgery after the most minor “syringing” and that’s the strategy with EVERY client with epiphora whom walks through their door.
I advise you not to fall into the spiders web and say NO to the surgery. Get a macrodacrocystogram, find an open minded ophthalmologist to perform balloon dilatation, stenting, etc rather than have your nasal bone drilled through. Makes sense? Hope so 🙂
OMG, I have an appointment with an occuloplastic surgeon next week and, to be honest, am terrified of the surgery. I saw an ophthalmologist and he is sending me on to this occuloplastic surgeon and said that I would probably need surgery to correct the eye that has the tear problem. I’ve read so many articles that say if you have a blocked tear duct that it requires the two-hour surgery under general anesthesia. I think I will cancel my appointment and just take my chances. Thanks for posting the information here.
Hi Makenzie, if you’re terrified of the surgery it’s sort of like a “gut feeling” that never lies to you. There is a saying, “If in doubt – throw it out”. You’re eyes are very precious and you want to avoid surgery there at all costs. If the procedure goes wrong, it’s permanent and like myself, you’ll be spending thousands on endless treatments for relief.
The countless articles you’ve read about a blocked tear duct requiring DCR is due to the occuloplastic surgeons “dominating” the procedure and labelling it the “gold standard” because it has a high success rate in terms of stopping epiphora. However, what they fail to tell you is the short and long term side effects. They fail to mention there are other non-invasive methods that patients would prefer to have a choice about. They may not be at the higher percentage rate in terms of ‘stopping’ epiphora (usually less than 90%), but I’d rather have a much safer surgery that does not alter my natural anatomy than worry about the symptoms of tearing to disappear. I’d rather a reduction in tearing through a safer procedure than complete recovery of epiphora.
We are all different, take a gamble or don’t. But remember what your gambling with.
Where are you located? I have had 2 surgeons want to do surgery! (Of course they do…..that’s what they do.) There is a wonderful procedure done in Japan by Dr. Toru Suzuki who does Lacrimal Endoscope Transcanalicular Endoscopy. It is done under local an. takes about 12 minutes and they do everything through the tear duct. I have written to Dr. Suzuki and he says he has tried to get American doctors to get interested in this procedure and they are not interested. His email address is: panacy@suzuki-eye.com I would be interested in hearing from you.
I just wrote to you regarding Dr. Suzuki. However, where would I find eye doctors that would do such things as stenting or ballon dialation. I have searched and can’t find any. I would also like the “x-ray” so there is no guess work. I even asked about it with one surgeon and he said it wasn’t available or necessary. I live in Illinois.
Hi Ruthie,
My advice is to move onto another oculoplastic surgeon after researching one who’ll do the X-ray (macrodacryocystogram) and the balloon dilatation with stenting. They are out there. Here is some advice I gave another responder…
1. Call a few dozen Ophthalmologist/Oculoplatic surgeons office and ask if they perform the procedure your mother prefers. Don’t be discouraged by everyone saying no, you will find them and they are out there. In fact, many prefer to use the alternative and safer techniques.
2. Call the companies supplying the surgical equipment such as the LACRIcath at Quest Medical – http://www.questmedical.com/products/ophthalmology/catheters.aspx Do a search for LACRIcath and see who else stocks it and whom they distribute it too.
If your doctor is not compliable with you, then it’s your right to move on and refuse. It’s your body.
I am 75 yr. old male with life long sjogrens/dry eye. This late spring, I developed excess tearing/ very dry conditions on a daily, and sometimes hourly basis. A blocked tear duct in lower lid has been diagnosed with subsiquent recommendation for DCR. In the exam, a shringe saline low pressure flush verified the blockage, but the same check of the upper lid drain showed that it was without blockage. My understanding is that the two drains are connected prior to entering the nasal drain. This indicates to me that the lower drain is blocked in that short section before the common connector. I this an incorrect assunption? And would the correct correction be a simplier clearing of that section with a more forceful saline flush?
Firstly, I’d like to extend my deepest sympathy for suffering with sjogren’s and dry eyes for such a long time. I could only imagine, 15yr ago and over, not many options at all existed for the condition. My epiphora occurred twice hourly and yours has only just appeared and less frequent. The lower tear duct can become blocked with dry eye due to a lack of moisture in the naso-lacrimal duct and due to general ageing. But as a dry eye patient, you should NEVER have a DCR. I would imagine the epiphora is a relief after having had dry eye for so long.
I want my epiphora back! dry eye is a LOT worse. I suggest you take the most conservative approaches and use warm compresses at the tear sac area, milk it with your finger and use anti-biotic drops (which used to ease my epiphora). If you have a DCR surgery, you’ll have increased drainage of tears because they enlarge your punctums and create a gaping hole in your nasal bone. Your eye will be so dry, the pain will be unbearable. It’s your choice, put up with some tears, find a surgeon to attempt ‘probing’ or ‘balloon dilatation’, etc or have the DCR. Once you have the DCR you cannot reverse it.
I totally agree. In all of my years of dry eye, it was never more than an inconveince, and at that, over the counter artificial tears more than adequately took care of it.
The watery eye is much more a problem, since in my case, the tears do not overflow, but remain on the eye. Then they dry leaving a thick film distorting the vision.. I will take the dry eye and go happily
The reason I am replying is to ask if my understanding of the upper, lower drain connection is correct, and that a much simplier unblocking is called for.
After re-reading your reply, it is obvious that I did not read it properly. My experience with dry eye was very managable, unlike what you are now experiencing. And my current difficulties with watering is also very different from yours. What is apparent to me, is that the worrysome questions I have following my doctors visits and thier recommendation of DCR surgery are the same as what you have explained in your blog and are very much appreciated.
Thank you so much for posting your story and all the treatments available for epiphora and blocked tear ducts. I have searched the Internet and found your site to be the most comprehensive, direct, and understanding in seeking answers and treatment.
I have suffered from excessive epiphora in my right eye for a year now. It began after an episode of what I think was blepharitis brought on by roseaca. I had recently started a new job (in January) and thought I was experiencing an allergy to mold or other external substance (the building was very old). By June, I couldn’t take the tearing and went to an eye doctor (opthamologist). He gave me drops (anti-inflammatory) to take for two weeks. I went back in two weeks after little or no relief, and he did the eye stain and saline irrigation. He said I had a nasolacrimal block and referred me to an occuloplastic surgeon. I went and he irrigated both eyes to show one was clear (tasted saline) and the other was blocked. He also told me I had slight dry eye syndrome (I’ve never been diagnosed with this, and I wear contacts daily). He said most likely a stone was the cause of the blockage due to dry eye. Told me it couldn’t be “roto-rootered”, but said I could try massage, but otherwise recommended DCR surgery. Feeling I had no other option based on his findings, I scheduled the surgery. When I came home, I did research, and what I found was horrifying! Scarring, drilling and removing bone, dry eye complications, continued epiphora… I cancelled the surgery and committed myself to finding alternative therapies. I left my job shortly after, and to my surprise, the tearing did not stop. So I found an osteopath in Sept. that listened to my story, and stopped the tearing for 2 months. Discovered I had a ton of hardened mucus in my sinus cavities. Put me on 1800mg of guaineffesin a day, saline irrigation, vapor inhalation, etc. This proved my block was either partial or not permanent! Sadly, the tearing resumed beginning of December. So I resolved to fight what I believed was constant and excessive inflammation in my body through diet (healthy eating). No more processed foods, caffeine, alcohol, and commit to tons of anti-inflammatory foods. I just finished 2 weeks of the mediterranean diet, and while I feel better, it hasn’t gone away. I am now doing 2 weeks of healthy eating and taking an NSAID to see if inflammation is really the cause, and preparing to get allergy testing for the first time ever (I am 39 years old). I also plan on cleaning my gut with a very specific diet targeted to healing leaky gut to further fight possible inflammation. But I am also, based on your site, recommitting to finding a doctor who will use non-surgical procedures and the right testing to truly identify the location of the blockage and put me on the right path toward good health.
Hi Jen, Thank-you for the refreshing reply and you deserve a congratulations for being curious and questioning your doctors suggestion of DCR. Afterall it is OUR bodies and they have absolutely no right to suggest how we treat it. What’s worse they keep information about the surgery, indeed, you had to find out for yourself. Yes, it’s rather gruesome. You are on the correct path by using all the natural remedies as possible. However, I feel you’ll need to have the block removed via a probing, balloon dilatation and/or stenting. Firstly, most oculoplastic surgeons will refer you to have a macrodacrocystogram to locate exactly where the block is, you must request it. It may not be a stone at all and could be a partial or full blockage at the distal end of the nasolacrimal duct (which will make it easier to treat non-surgically). So my advice is to find the location of the blockage, then locate an oculoplastic surgeon whom will work WITH you on a conservative level (they do exist!!!). Good luck in your search and please keep us updated with your progress.
George, I can’t thank you enough for replying to me. After another trying bout with tearing in February, I went to see a top occuplastic surgeon on Long Island, paying out of pocket to see him. Same diagnosis as the last with only aggressive saline probing. Although he did not perform an x-ray or identify the cause specifically, I discovered two important details regarding my condition… 1) I have a deviated septum on the same side as my NLDO, precluding me from an endoscopic DCR, and 2) This time, some saline did get through to the back of my throat, indicating a partially obstructed tear duct, both helping me realize that I need to seek out a doctor willing to find where the obstruction is, and one that will perform balloon, stenting, or both. My only symptom is watery eye… I am very good at pushing the stagnant tears out through my puncta, and occasionally through my nose. You are right in telling people to keep looking… that has been my biggest hurdle. I even contacted LacriCath and they said the doctor who uses the balloon was the same guy who refused to perform the procedure on me. I am fortunate to have found someone who had stenting done last year by a doctor nearby, and I have an appt. with the same group this week. My only other referrals are for pediatric eye surgeons who use the balloon technique in children, versus adult-only surgeons who go straigh for DCR regardless of how blockage came to be. Thank you… will keep you posted how it goes!
Thanks Jen for letting us know your progress. And it seems you are surely making productive progress. I’m so glad you have hung in there and avoided DCR, it’s so tempting to just “have it done”. Balloon dilatation works more effecively for partially blocked NLDO. So you are doing all the right things. Indeed, balloon dilatation and probing is used more commonly for paediatric care. However, it’s still being used for adults, and the studies clearly proves it works. I hope the new ophthalmologist or oculoplastic surgeon will agree to use the balloon dilatation and/or stenting on you. Please do let us know how you go. Thanks again for your feedback to date.
I am 87 years old and I have developed tearing on my left eye. My doctor tried the flushing but it didn’t work.
I have been reading the procedure about the operation. I am terrified of it. In your blogs I read that they drill the nose to open a new duct. I had dry eye before the tearing.
I have a simple question which I hope leads to a simple answer.
Will it be o.k. to live with the tearing and continue trying the hot compresses and the eye drop antibiotic? The tearing is not something that stops me from doing what I normally do, like reading, painting, watching TV, etc. I have an appointment with my primary next week.
Unless it will make be blind I don’t want the opeeration. Please let me know. Thank you.
Hi Joe, If you had dry eye before the tearing, you’ve possibly identified the cause of the tearing. Dry eye often leads to “drying and constriction” of the Naso-lacrimal duct (NLD) which should remain moist from the constant drainage of tears into your nose. With a lack of tear production, it dries up and closes, thus you end up with tearing.
However, a DCR includes snipping your punctum’s open and they become very LARGE, and thus more tears than normal will drain from your eye into your nose. Furthermore, the osteum (hole they drill into your nose) which is the new drainage passage is about 11mm, it’s huge compared to your natural NLD, so the tears drain out faster. To putting it altogether, a larger volume of tears drain from the eyes at a faster rate. Such a physiological function will severely aggravate anyone with dry eye prior to DCR. It will turn a mild dry eye into severe pain where you’ll have to keep it closed. I know, I experienced it!! I had some dry eye before my DCR and was never asked about it.
A more competent oculoplastic surgeon I spoke to informed she always enquirers if her patients have dry eyes or sleep apnea before performing a DCR. If they have either, she will not perform the procedure.
You are not a candidtate for DCR. Simply place some vaseline under your eye where it’s tearing to prevent skin irritation and wipe up residue. It’s better to have a moist eye than a bone dry eye with severe pain!! Infection can be controlled as it arises. All the best.
This is a just a thank you for replying to my email concerning DCR. I spoke with my Opthalmologist yesterday, who put me on a set of drops and some eye ointment. I discussed balloon dilation and stenting with him and he was fully in support of trying those procedures. The tricky part now will be finding someone who will actually perform them. I’m on the hunt right now and will inform you when I find a practitioner willing to do either stenting or balloon dilation. My Opthalmologist said he’s going to look into it too. Thanks again. Will keep you updated!
I am a 65 Year old female. In 5/07 I had smart plugs put in. 9/10 I had a canaliculoplasty to remove migrated plug due to eye infections. Was fine until 7/12 eye infections came back. I was told there might have been a piece left behind, and that I need a DCR. I have been on tobramycin and dexamethasone up until now 6/13/14. I have gone to an ENT doctor to make sue allergies were not the cause because it gets worse if I am outside. I was put on antibiotic nasal sprays and had a CT scan. Allergies for the cause of eye watering and infection were ruled out.
ENT doctor said I should get the DCR. Is there anything else I should do? I have been avoiding a DCR for two years, but my eye is getting worse and looking a lot older then my right eye. Have to put the drops in my eye two to Three times a day to keep my eye from swelling
HI Saundra, Smart plugs should be banned!! they are notorious for complications and even the research shows a poor success rate. They often migrate into the tear sac and naso-lacrimal duct. It’s a pity so many ophthalmologists continue to offer them. Luckily I knew about the complications and utterly refused when an ophthalmologist wanted to place them into my eyes. Rather, there are other products that have an almost zero complication rate and a better alternative to smart plugs. But that’s not your concern now. Many people I’ve spoken to have had to have a canaliculoplasty to remove the smart plugs. Yes, it’s possible remnants of the plug have migrated further down and collecting bacteria, thus causing ongoing infections. The problem is there is no way of using exploration surgery for the tear sac and further down (naso-lacrimal duct) other than having a DCR done because it’s all covered by bone. If you do not have dry eye disease or sleep apnea, you may have to resort to a DCR.
I have another comment.
My husband had tearing eyes all his life and he never complained or did anything about it. I don’t think any of his doctors ever mentioned the problem. If he lived with that condition and his eye sight was not affected, so can I. (He didn’t even have cataracts). He could read without glasses. Recently he died of Lou Gherig’s disease.
My eye duct has pus but I would prefer to have it extracted and use antibiotics than to go thru any of the procedures.
Hi again Jo, firstly condolences about your husband. It sounds like you were both together for a very long time. The causes of a tearing eye can be different. Your husband may have had drooping lower eyelids which moves the punctum’s away from the eyeball, thus not allowing the tears to drain (rather than a blocked tear duct which leads to infections).
Constant and chronic infections is a problem and antibiotics can be overused. Depending on the severity of the problem. You may wish to find someone to perform balloon dilatation on you. It’s safe and is a very simple in-office procedure (no hole is drilled into your bone). If it works, the infections should stop. Please do think about it 🙂
Hi-just returned from my Board Certified Opthomologist – a few weeks ago had “dry eye” diagnosed-after having itchy-flaky eyelides and ointment for that- (daughter had same thing when she was young) that seemed to clear up- then the dry eye- NOW I have the tearing and sticky eyes when I wake up. My Dr referred me to a BC facial and eyelid plastic surgeon that performs the DCR- called ofc to schedule appt and asked about procedure –
She even gave me your website – NO way will I go into that surgery! ! It sounds Terrible!! Having read your site and others’ experiences, may try an alternate treatment – even plan on trying to find a pediatric eye surgeon as mentioned by one of your writers. General anesthesia !! Drilling thru the nasal bone!! No Thank You!!! Thank you for your info – will be checking in again! ! Murph
Thank-you Barbara for informing us. Please let us all know if you find someone to perform the less invasive office procedure treatment. We all like to know how people have improved with it and possibly compile a list of eye surgeons willing to perform them since they are all too obsessed with aggressive surgery “for a simple bit of tearing”. It sounds suspicious from the start doesn’t it? I wonder if your eye doctor mentioned the DCR involves drilling through your bone, massacring your tear sac and snipping your punctum’s to oblivion? I’m VERY happy to hear you’ve decided against DCR. Good luck with your search for a less invasive procedure. Don’t give up, they are out there, and they work.
From the Great Plains of SoDak: Was planning on going thro with External DCR that my opthomologist said I needed. I knew absolutely NOTHING about this surgery….didn’t know they even did surgery on a blocked tear duct…..didn’t know what questions to ask….I did ask the nurse what was the name of this procedure? so I could check it Online…..found your site…..glad I did. Meanwhile, I have a month to decide what to do. I’m sending a letter to opthomologist (very nice, but telling him I want him to try a different alternative) I’ll give his office my phone # and email address for them to reply. Checking the yellow pages for other eye doctors in case I’ll need a second opinion. It’s my dear eye, nose and surrounding area that’s at risk.
Hi….I have a completely blocked right tear duct and was just evaluated and recommended for surgery. I have been experiencing the dry eye that cries syndrome for over a year and a half so I am not eager to jump into the DCR quickly. I am on restasis for dry eye. What are my options? The surgeon stated he preferred to make the incision on the outside of the eye but gave me the option of through the nose because of my concern of scarring. Appearances are important. Apparently, through the nose has less chance of fixing the issue and both have a small chance of causing a leakage of cerebral fluid. With this said, I could probably just live with this condition.
Thoughts? Thanks George.
I gather the eye you’re using restasis on is the ‘other’ eye? The eye that’s currently tearing, was that also dry at some stage? Did you know DCR should never be used on anyone with a history of dry eye? The tearing can be caused from dry eye, and imagine DCR creating a larger hole for any minor tears you’re making to drain through quicker. The result is a significant increase in dry eye symptoms. So a teary/watery eye will become a bone dry eye. That’s what occurred with me, and others, and we all wish we had our teary eye back. Indeed, dry eye is far worse in terms of discomfort and long term damage than a teary eye.
I had an endonasal DCR where they go in through the nose. They still drill through bone. All the complications were the same, it’s just glorified since it’s on the “inside” rather than the “outside”. Avoid it at all costs.
Hello, everyone. First of all, thanks to everyone for sharing their stories and especially to you, George, for giving us the platform in which to share and giving us the straight scoop (so glad to have found you). I’ve had a teary right eye for more than a year now (started in May 2013). My primary doctor’s nurse said it was “no big deal,” that she had one too, so I didn’t worry about it. (I had been diagnosed with Sjogren’s and dry eye syndrome a few years ago, among other annoying health issues, including chronic headaches, and decided it must just be something else I had to adapt, just one of the plethora of inconveniences I’ve had to adapt to for years.) Since I use my eyes for work every day and do so on a computer (full-time), I thought I’d better check in with my optometrist. He said it was probably just a “virus,” and basically said there wasn’t anything I could do that I wasn’t already doing. So then I wondered if it was from a tooth or something and saw my dentist. She didn’t find anything. My primary doctor (who I love!) thought a round of antibiotics wouldn’t be a bad idea, just in case it was my sinuses. Flash-forward months later, eye still tearing, and my husband has an eye problem and is referred to an actual eye doctor (ophthalmologist). While at his appt., he mentioned to his doctor what I’d been struggling with, and she suggested that I come in. I made an appt. and found out that I had full blockage of the right lacrimal (she did the basic syringe test), so she referred me to an ocuplastic specialist (we don’t have any locally, so I traveled out of town to see one). First, I must say that it was good to learn the difference between an optometrist and an actual eye doctor. Had I known the difference, I could’ve saved myself some time and money. I learned many valuable things from her (one being that I have ocular hypertension and need to check in every 6 months or so; another being that since I have hypertrophic scarring, I should never let anyone cut into my face). The appt. with the oculoplastic specialist was…well…weird. I was glad my husband was with me so I could ask him if he felt like we’d entered the Twilight Zone. The only physical exam this dr. did was push his finger into my right tear duct area and ask if it was uncomfortable. I have quite a bit of swelling on that side, so the area is about the size of a large pea underneath the tear duct. I replied, “yes,” so he basically said I needed a DCR and had me schedule one. He gave us a cursory explanation of what the surgery entailed (which raised my first red flag). He also mentioned that I might have to get my deviated septum corrected before I could have the DCR done and suggested I see an ENT in my area (it’s deviated on the same side as the blocked lacrimal). We left his office feeling uneasy and decided we needed to look into it more and prayerfully consider going forward. Fortunately, I did see an ENT and felt that he was very helpful. Off the record, he basically said, “If you were a relative of mine, I’d tell you not to have the surgery.” (Isn’t it sad that anything has to be “off the record” when it comes to getting the best medical advice we can? Our health system definitely needs a total overhaul!) For the next three months, he is having me do nasal saline rinses (which I’ve used in the past) and nasal steroid spray. So far, all it has done is increase the severity of my daily chronic headaches, so I’m not sure what I’ll do at this point. I’ve never had to blow my nose, like my healthy husband does (numerous times a day), especially in the last few years (though I had sinus problems when I was younger). There’s nothing there to blow out. I’ve always thought this was odd, but perhaps it is connected to allergies or the autoimmune disorder (which definitely affects all my mucous membranes). At this point, regardless of how annoying and uncomfortable it is, I’m going to live with the weeping eye. The DCR sounds extremely invasive, and as the ENT told me, it isn’t always a success and can sometimes create new problems (he said he has known people who’ve gotten it done who still have a teary eye). Most important, he said it’s a surgery that can’t be reversed. I live about five hours away from a large Pacific coast city, so I’m going to eventually check into the alternatives you’ve suggested here and see if I can find someone there who will help. I do have to say that in my life, as I’ve gotten older (in my late fifties), I’m trying to learn to trust my gut, and it was telling me all along to cancel the surgery (I have a really close friend who was raising red flags too, who was very relieved when I cancelled it). I felt such a wave of relief when I called the office to cancel (as a side note, the receptionist was extremely unprofessional and rude, which my husband said was another reason not to entrust my medical care into this particular medical group’s hands…egads!). I know the journey isn’t over, but I have hope that I will find someone who is willing to help; someone who will do what’s best for me and not just what’s convenient for him/her. I wish that for all of us, regardless of what decisions we make. Thank you for helping us toward an informed decision. C.
Hi Cate, thank-you so much for your detailed post. It’s stories like yours that I like to hear, people making independent decisions about recommended surgery. Intuition is the best mark for any decision, if you have a “gut feeling”, you’ll always be doing the right thing by following it. Unfortunately for many, their inner guidance is clouded through desperation for relief. So I am glad you were able to follow those feelings that “something isn’t quiet right” about DCR and the “arrogant” receptionist confirmed that!!
All the best with your future management. Please keep us informed.
Thanks, George. I sure will!! Sending my best, Cate
I know this is an older post, but I have to say, not all doctors are like this. My daughter has had chronic eye issues for over 2 years, and finally got to see a dr. that verified it was a blocked tear duct (others were stating allergies, but after I insisted on allergy testing, she is not allergic to anything). She has been on steroid drops, antibiotic drops, and is having her second stent put in tomorrow before doing a endoscopic DCR if this one doesn’t work. There are some good doctors out there. That saying, it is good to research and be knowledgeable enough to ask questions, but I don’t think we should be saying that if they don’t do this or that right off the bat, that they are bad doctors.
Hi Rachel, how old is your daughter? We are always looking for eye surgeons who perform stenting on adults with epiphora. However, on the chance she’s a child, I must advise that the url says, ‘blocked tear duct surgery adults’. Basically, children have softer and more flexible nasolacrimal duct linings and thus have a higher success rate with stents and probing. However, I am saying stents/probing also have a role with adults too and they should be offered that choice rather than thrown directly into a DCR operation which is what a majority of eye surgeons do.
Hi George,
I am an adult with a blocked tear duct for 10 months with two infections. I was referred to an occuloplastic surgeon for the DCR surgery (which I do not want). I had syringing done and there was a lot of resistance with fluid backing up, but the saline pushed through at the end, although this did not improve my symptoms. Although the surgeon strongly pushed the DCR surgery I refused. He then agreed to do probing at my request. He said the obstuction was between the lacrimal sac and nasolacrimal duct and that he was able to push through it and when he retracted he said he syringed water that went though so thought that might fix it. Great, except my symptoms still persist. I have a follow up appointment with him soon and don’t know what to ask for next…is there a chance of another probing working??
At my initial appointment when I asked about balloon dilation he said that only worked in children. When I asked about stenting he said that you had to be under general anesthesia for this so might as well do the surgery. I have printed off the studies you list to educate myself to be prepared.
My tearing is minimal (which I can live with), but it is more the infections being the reason I was hoping something would work.
Thank you very much! Your information is great and very useful.
I admire your hesitation with DCR and it seems you’re thinking before jumping into anything. They will tell you Balloon dilatation and Stenting is only for children. This is not entirely true at all and studies prove it can work very successfully on adults. Yes, please do show them the studies and don’t let them talk you out of these passive alternatives. I’m at a loss to figure out why the patients concerns are not taken into account. Perhaps they know more money can be made by doing DCR?
Stenting is not done under general anaesthetic. Such a comment seems to be coming from a surgeon desperately trying to convince you against it. I’m extremely proud of you for holding your ground and backing your self up with research. Tell them you don’t appreciate your concerns being ignored and you’ll find someone else who treats you with more dignity.
You best course of action is to find a surgeon who performs balloon dilatation and stenting on adults. They are are a minority but definitely available.
I’d encourage anyone reading your post to take it as an example of how to approach the situation with surgeons.
Good luck and please keep us informed.
Just thought I would update my progress (or lack thereof unfortunately). Since my last post in December I have had another infection and also had more extensive probing done where the doctor inserted about 6 different sized probes into the duct. Unfortunately, this was not successful and made no difference.
My problem is really the infections…I can live with the watery eye. I have been on three rounds of oral antibiotics with eye drops in a year….how much is too much?!? My tear duct is also sore as I type this. Not sure if an infection is starting or maybe I was a bit overzealous with the expressing?? We shall see.
I REALLY don’t want surgery, but feeling like that may be my only option. If the probing didn’t work, it doesn’t seem like balloon dilation would. And even stenting is starting to look hopeless as well since the other methods haven’t even made a bit of a difference.
Do you know if you HAVE to have general anesthesia for stenting? I want to avoid being under if at all possible.
Anyone heard of going in for duct irrigation on a regular basis to possibly hold off infections??
Again, thank you so much for this blog and I haven’t even found anything else out there even like it!
My tear duct is infected again (deep sigh!).
I was scheduled to have DCR on March 5 but cancelled after researching the surgery and reading this website. Thank God for you George. I had no idea that a ole will be drilled into mynasal bone!!!!!i experience excessive tearing only No infection.
Dear Susan,
Thank-god indeed. Many surgeons performing DCR don’t inform it involves drilling a “hole in your skull” which is basically where the nasal bone is. There’s a myriad range of complications (go to my complication section), whilst rare, it’s just not worth it when it comes to our very precious eyes. If you’re only tearing without infection, you can place some vaseline where the tears drip down to avoid long term skin erosion, or search for a surgeon who’ll treat you conservatively. My recommendation is not to live with it, but spend your time searching for someone who’ll attempt to firstly “locate” where the block is, (is it a full or partial block? where is it located?), then attempt to simply probe it through. The probing may bring about relief for a few months or longer. If you need further intervention there are certainly balloon dilatation and stenting….no drilling involved and no permanent alteration of your anatomy. It’s your body, you get the choice of what happens to it. Good luck in your choice, and please look after yourself.
Hi George, I wish I had seen your blog before having DCR surgery. I had it in Feb. of this year. All seemed to go well until a few days after the surgery when my eye got pussy and stuck shut. The Dr. cleared that up and prescribed some eyedrops, and nasal spray. But my eye still waters nearly as much as it did before. Fortunately, I have had no worse complications, but the Dr. now says it looks like he’ll have to repeat the surgery! I do not want to do this. I feel that if it wasn’t successful the first time, why do it again? My question is, can the less invasive procedures you mention be successful after a person has had an unsuccessful DCR? For example, could I still benefit from the balloon procedure? Thanks for your help!
I am scheduled for DCR surgery on Monday and I am trying to do some research to see if I should proceed with the procedure or not. I started having excessive tearing last month and was referred to a eye dr that referred me to a eye surgeon. The surgeon did the test where he puts the saline in syringe and see if you feel it in your throat which I didn’t and he set me up for surgery. My eye has gotten much better and it does seem to be watering much at all but I can still feel that little fluid pocket next to my eye area and I am concerned about the tearing returning and that is why I was going to still do the surgery but after reading all the comments above.. I wondering if I should ever proceed with it?
Hi Nikki,
Wow, they are throwing you into the deep end without any conservative approach at all. The fact you only developed a watery eye one month ago is enough to discourage any surgery. The usual treatment plan for watery eye is to firstly use anti-biotic and anti-inflammatory eye drops along with massaging the corner of the eye. Sometimes it can clear up on its own. Wouldn’t that be the best (and most logical) course of action?
If you’ve noticed a slight improvement of the tearing, well, it can come and go. You may notice an improvement and believe it may go away, but then the water works start again.
I’d go with the drops and meanwhile ask for a macrodacrocystogram to locate exactly where the blockage is. You could also phone around and locate a surgeon who will “probe” the area for you and use balloon dilatation. I discourage DCR surgery.
My right tear duct has been blocked for a year. I backed out of dcr surgery because I was scared of it. But I really feel like my right cheek has gotten fatter, my eyebrow seems lower, and the area right below my eyelid seems swollen too. It is not infected. I can live with having to drain the tears out, but I’m worried about my face swelling. Does anyone else have this problem?
Hi All, I got a external DCR and I’ve talked to my optomalogist and he said he can close the hole into the nose but it would be really risky and he hasn’t ever done this before. He said the bone does partially close the hole over the long term (I got DCR almost five years ago). I have an appt with a specialized ENT my eye doc told me to see about if a surgery can be done to close the hole from inside the nose. Anyone have experience on this? My case is a little different, I put in old contacts, got an eye infection in both eyes then over time it went to my tear ducts, went to an eye doc that does external dcr and he did one syringe test and said right one isn’t fully blocked but left one is almost completely blocked so I rushed into DCR, got the left side done, the blockage in my right side cleared and completely healed after around 9 months. The left side always gives me problems, air doesn’t blow on my eye but a lot of times the tears going down will come back up if I raise my voice, cough, sneeze, blow my nose, sniff and then my day is ruined because the corner of my eye gets red and it takes a whole day to recover.
Why try and get rid of it. Its not serious. Ju st embrassing cos people think I am crying.
I read this blog off and on for a year while putting up with a blocked tear duct. I tried all the natural remedies but non of them worked. Because of all I read on this blog I was opposed to the DCR surgery and I had never had any surgery before, so I was double scared. Then I had too many eye infections and two anti-biotics didn’t work, so I saw a second DCR surgeon and decided to have the operation. I am very pleased to report that it was a complete success!!! There was no pain, no bruising and I am tear free. I wish I had read more positive experiences earlier and I would have had the surgery earlier.
Thank you, I’m in a similar ultra-scared position to were you were, and wondering how you are now, more than a year later? The surgeon I spoke to yesterday was so thorough, gracious and gentle. He recommended a DCR through the nose, took enormous care to answer all my questions, and he recommended watching it on YouTube (OMG it looks horrendous!). When I asked if he would honestly be prepared to recommend and do the op on one of his own loved ones, he said “of course; I would never do it for someone else if I wouldn’t do it for my own”. If I were to go ahead, I’d want him to be the one to do it, yet if I wait, there might never be the chance that it would be him again. Yet it seems such a drastic surgery. Does it feel very different now from how it always was before the blockage? Does the bone grow back or are you left with a soft patch? What happens to your tears if they have dissected the lachrymal sac? I’ve so many questions!
I’ve kept up with this blog and have delayed having surgery for two years. I have tried probing, steroid drops, and flushing. I would like to try a DCP before a DCR but there are no surgeons who do it. I’ve met with 7 so far. Is there a database to turn to in order to find names? I can’t continue living with a tearing eye as it’s very obvious and annoying. Also, I would like to hear if there are any success stories for the endonasal approach. It’s hard to believe so many Drs would suggest this approach if it’s the worst option.
Hi Lauren, I understand your frustration. I fell victim to DCR for the same reason. After having consulted a few ophthalmologists and oculoplastic surgeons, they only recommended DCR. However, I was unaware of the alternatives. I recall asking them to “probe” the blockage but they refused and declared it doesn’t work. So I had the surgery! ….
Sure, it cleared up the tearing. It works! that’s why they have all suggested you have DCR because it’s considered the ‘gold standard’. But at what cost? You maybe swapping a tearing eye for severe dry eye? or other complications (see my list of complications).
Unfortunately, there’s no database of oculoplastic surgeons and what techniques they use. One strategy is to contact the manufacturers of the equipment they need for DCP, eg: http://www.questmedical.com/products/ophthalmology/lacricath.aspx and ask if they supply any local eye doctors in your area. Then phone them all. This strategy worked for me “after” I had already had DCR. I got curious after unearthing the alternative methods I was never informed about. I obtained a list of every ‘oculoplastic surgeon’ in my country and rang them all. From all of them, only a small few in Australia will use alternative ‘non-invasive’ methods for epiphora in adults. In fact, one or two ‘only’ uses the non-invasive methods and was anti-DCR (very surprising). It’s amazing what some research can do.
There’s no point making random appointments with eye doctors unless you phone and ask if they’ll do as you ask. Phoning and simply asking the receptionist ‘Will Dr. …. use Balloon dilatation and/or use a stent for adult eye tearing. I wish to avoid DCR’. The receptionist will ask you to make an appointment and inquire yourself in person, then you demand they ask him/her on your behalf. Whilst some practices will only be too delighted to provide the information over the phone.
Try my strategy and see how you go. Good luck! … and do let us know how you progress.
I had a probing done and the doctor confirmed I have a partial block since the rod went all they way through. I’m now on steroids for a week. However, I do have an apt coming up with a dr that says she does DCP. I also made an apt with the creator of the LacriCath in case my upcoming apt doesn’t pan out. This means getting on an airplane and traveling to see him. But it may be worth it if the problem can be cured with a DCP. This process hasn’t been easy to say the least. I’m learning many drs who use this approach only do so for kids.
Quick update on me.
I had the stenting done. They put me under general anesthesia to do this. It failed miserably. The doctor couldn’t get the tube through my eye. Therefore, a month later. I had no choice but to proceed with the DCR. I got it done and I’m no longer crying! I have no bruising and my eye is functioning normally again. I wish I wouldn’t have waited. Endoscopic DCR is the way to go for a DCR if anyone is debating between the two. I honestly could go back to work the next day. My face looked completely normal. I was just tired from the anesthesia. Good luck everyone!
Hi Cryinggirl…you’ll have to change your name now 😉 … I was just going over comments, and some require my advice and others don’t. I noticed I didn’t respond to your comment since you were mostly letting us know you had a successful DCR. I’m very happy it worked out for you without any complications.
It’s been over one month now, is everything still fine? Are you having any air regurgitation upon breathing and blowing your nose? It honestly, doesn’t happen to everyone, but is a very common side effect. It also doesn’t bother many whom it occurs too. There was one guy whom had a DCR and uses a CPAP machine for sleep apnea. After his DCR the air that the CPAP machine blew into his nasal cavity diverted into the DCR hole and onto his eyeball. It was very painful for him. His only option was to have his punctae cauterized.
I absolutely agree with you that the Endonasal DCR is better than the external approach and it’s a shame more surgeons don’t offer it. What’s even worse are surgeons that don’t INFORM patients that there is an Endonasal approach. Knowledge is power, it always pays to use the internet and do some research!
Good luck with it all, and hope you’re doing well now.
Quick update on me.
I had the stenting done. They put me under general anesthesia to do this. It failed miserably. The doctor couldn’t get the tube through my eye. Therefore, a month later. I had no choice but to proceed with the DCR. I got it done and I’m no longer crying! I have no bruising and my eye is functioning normally again. I wish I wouldn’t have waited. Endoscopic DCR is the way to go for a DCR if anyone is debating between the two. I honestly could go back to work the next day. My face looked completely normal. I was just tired from the anesthesia. Good luck everyone!
Hi George,
I’m extremely torn between having the DCR procedure or just leaving it alone. I’m not sure if I am a candidate for the other procedures. I have a congenital eye issue and when I was in 8th grade my eyes were were “moved” closer together due to hypertelorism. Initially my left tear duct became blocked and it was resolved by probing. Now I’m 43 and my left tear duct has been blocked for many years. Not since my recent move to Oregon did it bother me so much. It affects my everyday life and I’m am constantly doing things to make it better, applying make up, in the bathroom expressing it, etc. The ocular plastic surgeon said that DCR is my only option. I had an orbital CT done and it shows cystic lesion in the right nasolacrimal duct measuring 1.2×1.2×1.3 cm. Likely acquired right dacrocystocele with mild expansion of superior right nasolacrimal duct. Help 😉
I mean my right tear duct obviously. My left is corrected.
Hi Autumn, Whilst I always hold a strong and firm stance against DCR, there are situations where it is warranted. Your situation might be such a case! If you have a lesion within the naso-lacrimal duct then the ‘DCR alternatives’ may not work because the lesion will prevent them.
In reality, not everyone will experience all the complications as I did with DCR. May-be time to consider it? I’d go for the Endo-nasal DCR over External-DCR and make sure you’ve done your homework regarding the surgeon.
Let us know what you decide to do and keep us informed along the way. Good luck!
Hi Autumn, I was just scanning through my responses and noticed there’s no response for you. Strangely, I recall writing the response because I remember the “lesion” and suggesting DCR may-be your best option given you have a “structural” deformity that may render the less invasive procedures unsuccessful.
It’s great you had a scan of your naso-lacrimal ducts. So they’ve discovered a lesion in your naso-lacrimal duct! That could suggest that a balloon dilatation or stenting may not work. Thus DCR seems to be your best option. It’s difficult for me to suggest DCR because I am VERY MUCH AGAINST THE SURGERY due to the bad luck I and many others have had with it. On the flip side, many have had no problems with it either.
I still can’t say ‘Go and get it done’. However, since you’ve had the problem for so long, the writing is on the wall. Perhaps you’ve already had DCR by now? If you haven’t had the surgery and plan too, I’d suggest the Endonasal approach over the external DCR. Please do let us know where you are at this moment in time. Are you still suffering a leaky eye? Have you had surgery? We care and we want to know!
Look forward to hearing from you 🙂
Hi Autumn, I was so nervous about having a DCR. I waited two years and I couldn’t stand it any longer. I had an endo-nasal DCR three weeks ago. It was a positive life changing procedure for me. I am thrilled that I had the courage to do it! I had no bruising, no pain, and felt fine one day after. I didn’t have to take any pain meds at all. That was remarkable considering I have a low pain tolerance. My eye has no issues now. I can’t believe I waited so long.
I don’t understand why more doctors aren’t doing the endo-nasal approach. It’s amazing with little to no recovery. If you’re willing to fly, see Dr. Strong at UC Davis (Sacramento). He is incredible.
I think most oculoplastics use the external approach. In my case the oculoplastics department referred me to ENT. I was surprised by this but in the end it made sense since you have to use an endoscope through the nose.
I think most oculoplastics use the external approach. In my case the oculoplastics department referred me to ENT. I was surprised by this but in the end it made sense since you have to use an endoscope through the nose. I hope this helps a bit. Good luck!
I’ll have to agree with Cryingirl that Endonasal DCR is better than the external approach. The reason most don’t perform Endonasal DCR is because it requires special training. Often, they require an extra surgeon specialised in ENT.
I have had 5 DCR surgeries I the last couple of years at the VA hospital. All of them have failed and now all I have is a scar along with a teary eye. Are there any alternatives now for me, or do I just have to resign myself to always having to explain why I’m crying?
Amy have you tried an ENT that specializes in DCR? The reason I ask is you may have a better result. I went through the endonasal approach and my eye is back to normal and functioning perfectly with no scar. The recovery was a breeze and I was back to work in two days with no bruising at all. It may be worth looking into.
I have read many articles about this, also have had this in one eye for probably 8 years, but here is the crazy thing, I have tried many things but I have stopped energy vitamins, less milk and no processed sliced meat that I used to eat a lot of. It has completely gone, it has really gone not temporarily as in the past. I am amazed, this was a big problem and really bugged me, my Optometrist gave me only one option to have the surgery and that was that, he was wrong.
Ian, are you saying that your problem is due to allergies? Did you work with a professional to discover this?
Ingrid, the professionals just told me they did not know what could be causing this and gave me one option surgery, I took it along myself to find out if it was something else. I am still fine and can even go outside on a really cold day and have no symptoms.
My mom (age 82) has been diagnosed with glaucoma and has had 3-4 eye surgeries. She has a pace maker and fibulator. The tear blockage is in her RIGHT Eye…the only one that she has vision. Her issues stem from the boil or rising (rapid growth…pulse…the whole thing) that has occurred twice due to the blockage. It is a horrific episode. She has had to have it lanced twice. As she continue to take antibiotics (though we administer probiotics), it works against her body and has caused c-diff. DCR has been recommended twice. Suggestion???
I’m sorry to hear your mother is going through that. There’s nothing worse than losing your sight. Whilst I’m against DCR surgery, I’m reluctant to advise on the other alternative treatments. They take too long to find an appropriate doctor and your mother doesn’t have time on her side. So…
…in this rare situation, it might be best to simply have the DCR. But I’d insist on ‘Endonasal DCR’ rather than the external technique.
All the best and please let us know how your mother is progressing.
I have found your comments helpful being I myself have an appointment for external DCR surgery in a few weeks. I had the ballon catheter done under sedation, and a stent was left in for only two week due to major infection and discharge. I was on the antibiotic/steroid drops prescribed and later oral antibiotics. To no avail after I requested the stent to be taken out. Right after the stent was out, by the next day the infection, which was so bad, my eye was cleared up from it. Tearing came back and daily crusting and wiping is now a part of my life. Went back about three weeks ago and now External DCR is my next procedure. My feelings for this procedure is very unsettling. I lay awake at night so unsure about this…as irritating as my tearing and crusting is should I proceed with an invasive procedure? What if infection sets in again being a stent is left in the eye for 3-6 months and now with the nasal hole…how dangerous can this be for me?? HELP
Hi Kay,
It can be very distressing indeed. It seems you’ve already tried the conservative treatments and they didn’t work for you. Maybe see how you go over the next few weeks. Have you had a scan to see where the block is located? I’ve had people with simply ‘cysts’ causing a block at the distal end of the nasolacrimal duct and they were able to have it removed successfully and no further problems occurred.
Perhaps more diagnosis is required.
Thank you for your quick response! I have made the decision to live with my left eye tearing. I have had four surgeries on this eye being it all began with a little cyst below my lower lid in the bag area. The Ocularplasty Surgeon removed it by an incision on the inside of the lower lid. I felt that the lump came back quite quickly and was not totally removed. In the mean time I get a call back saying that the biopsy of this little bump was a formation of a bacteria that was non- tuberculous mycobacteria.Eventually the lump that came back was removed in an outpatient hospital by making an incision on the side of my left eye and going in and cleaning out whatever was there to get rid of this bacteria. So the next step was for six months a heavy duty course of two different antibiotics or it not tolerable IV. I tolerated it with huge side effects and lots of praying the bacteria did not return in any form of a lump. And the reason I am telling you this is because after doing the balloon procedure and dealing with the infection of the stent, I felt my gut telling me to stop! What if this bacteria which is so hard to get rid of is some how still in the back of my eye somewhere. If I drill a hole though a bone and this bacteria spreads int to my soft tissue I would not be able to deal with that.And I think this is one of the reasons for the tearing because of trauma to this eye.After reading your helpful and truthful experience I will not take the chance. I know there are some who feel their surgery was a success and I am so happy for them. But some of us are not as lucky and our bodies respond to doing the unnatural to it. So my question to you is if you have any tips you have come across that would make dealing with the runny eyes easier. I have not been able to wear any make up on my eyes being it runs. There has been a lot of adjustments and apologies whilst at work for my wiping my tears. But I have decided wiping it would be better than taking the chance of anymore infections with consequences. No one has ever offered me a scan to see where the blockage is. But with the ballon catheter it went right through and when the stent was left in I had no tearing..but than got infection set in really bad and was resistant to antibiotics. Thank you for sharing with us all what you have experienced and learned. Your site was so helpful to me and might have saved me from more sorrow.
Kaycee, I’m glad you’ve decided to live with the tearing for now. But if it gets too overwhelming (frequency), you’ll have to take further action.
How often do the tears roll down your cheek? Once every few minutes after you wipe it? How much does it bother you? Is your skin irritated from the tears?
What I suggest trying is to place a dab of petroleum jelly where the tears roll over your face. It usually decreases the frequency and protects your skin.
George,
Tearing is constant where it interferes with my vision. Some days it is less in the evening, but some days it is all day wiping. Funny how something so small can be depressing. When I work I can’t read to well so dabbing constantly. It rolls down the cheek but mainly it’s the thick layer of tears that interferes with my vision. Also the crusting is so embarrassing. So some days I think I can live with and others I am very frustrated.
I will try the petroleum jelly for sure.
You are so kind to help us all.
So it’s interfering in your every day life and making you depressed. Indeed, just a ‘small’ problem like an eye can cause a whole world of grief. You have every right to feel depressed at times about it.
Sounds like you really need to get on top of the problem. You’ve tried the conservative methods and they haven’t worked for you. I wonder if just a simple ‘probing’ might help relieve symptoms for awhile? If your surgeon was graceful enough to use the conservative treatments, I don’t see why probing wouldn’t be an option.
DCR is only the very last resort.
Thank you George for your time and interest with my issue. I will move forward in resolving and or living with t
his issue.
You are a kind person to take your time out to help others.
Wishing you the Best each and everyday!
Much Gratitude,
Kaycee
Hi George,
Thank you for the blog and site. I found them very helpful. I started having a teary right eye when I was 32 years old. My ophthalmologist performed probing and irrigation under sedation and I was fine for over 3 years. My eye went back to normal the day after the procedure.
However, 6 weeks ago the tearing started again. The same ophthalmologist performed probing under sedation. Although the tearing stopped for a few weeks, it never went back to normal with a high tear film. For the past 2 weeks, the tearing has come back. The ophthalmologist prescribed a nasal spray to use for 3 weeks and then wait another 2 weeks before seeing him again. He also recommended I massage down the right side of my nose in this time. Hopefully the tearing will go away… If it does not clear, I’ll ask the doctor to do an x-ray or scan to determine where my tear duct is blocked before any other procedures.
Your blog has been very helpful, however do you know where I can find more information about epiphora and a blocked tear duct for people at work and wearing glasses? I started a new work last week and it has been a challenge, as it is very visible if I don’t wipe my eye. Tears build up very high and then about an hour apart come running down. I’ve been going to the bathroom to wipe my eye very frequently. Wearing glasses also makes it difficult to quickly wipe my eyes at my workstation or in meetings. I’m very worried about how this will affect my new work. The splatter on my lenses is also a frustration. If I didn’t wear glasses, I think the condition would be easier to manage.
Thanks again, your information is very helpful.
Hi Waldo. Your example that probing can work is what readers need to hear. You got 3 years relief from the first round of probing which shows it really can work. It’s unfortunate the tearing has returned, and probing is not as effective now.
Supportive sites for epiphora are practically non-existent. Rather than trying to cope with the problem, it maybe time to look into resolving the tearing. Would you be open to the possibility of using balloon dilatation and/or stenting?
Hi George! Thanks for all the information here. I’ve experienced epiphora for several years and finally was referred to an occuoplastic surgeon. While at the appointment it was determined that I have lacrimal puncta agenesis, which means I was born without puncta in either eye. It definitely explains the epiphora at any rate. Of course, DCR surgery was recommended and an appointment was booked. However, as lacrimal puncta agenesis is fairly rare, and there are no puncta present at all, do you have any advice about alternative treatments? Thank you!
Hi Evan…There are two ducts for tears to drain through into the nose. The first is from the surface of the eyelids, specifically the ‘puncta’ located on the edge of the eyelid near the nose. They drain into the puncta, then through the canaliculus into the ‘tear sac’…where the tears finally go through a longer, very narrow tube called the ‘Naso-lacrimal duct’. So you have an upper and lower drainage system.
With Lacrimal puncta stenosis, the upper drainage system is absent. Thus DCR is not the surgery of choice. DCR is only recommended when the lower portion of the lacrimal system is blocked, the ‘naso-lacrimal’ duct.
The correct treatment for your condition is the insertion of a Lester-Jones Tube. A DCR operation will do absolutely nothing at all. You may wish to read this research paper to further clarify my point: https://www.ncbi.nlm.nih.gov/pubmed/8259286
I’d suggest consulting another surgeon!
Keep us informed and good luck on the road to relief!
Thank you! I’m afraid I was mistaken though. I was under the impression that a Lester Jones tube insertion was just another type of DCR. A Jones tube operation is what ive been prescribed.
Yes so many people do get terms mixed up. A Lester-Jones tube and a DCR are two completely different procedures.
If you were born without a puncta opening, wouldn’t you have been tearing since a child? When did it commence?
Regardless, a Lester-Jones tube will be your only option and there are no real alternatives.
Yes, it’s been noticeable most of my life, but has fluctuated depending on where I live. I recently moved to a drier climate, and it seems to have gotten worse. Only recently was I properly diagnosed and had a treatment recommended. What is your opinion about the quality of life after a Lester-Jones tube has been inserted? The tearing is often uncomfortable and has caused small infections in the past, but it hasn’t become unbearable per se just yet. Just trying to weigh the odds. For example, Is any bone removed in the Lester-Jones tube operation? Thanks!
Evan: The Lester-jones tube is a pesky thing to insert and keep in place. I’ve received many emails from people who experience it sliding out again after insertion. That’s not to say it will happen to you! But be mindful that it may not work on the first attempt.
On the positive side. It’s not a procedure that will totally alter or damage your lacrimal drainage system. They don’t remove any bone at all with Lester-Jones tube insertion. Bone is only removed with a DCR which is a completely different procedure.
Hi I have a dacryocystitis acute abscess please help me what I’m doing coz my doctor said I do DCR procedure but I’m so scared operation please help me ASAP,
Hi Melanie…your comment slipped through my system somehow. So sorry about that. What have you decided to do?
George, I came across your site today and am quite surprised at what I’ve read. I am now looking at a DCR as an absolute last resort. I’ve seen three ophthalmologists over the last two years who all are suggesting DCR. I was about to make the call and get it scheduled as this week has been bad for the tearing. There is one thing that I would love to get your (and others’) responses. In addition to tearing and that gunky feeling in the corner of your eye during the day, I also get extreme dry eye during the night. The last several nights, I wake up because my eyes are so dry and I have to add drops. Every several months or so, I will even awake to where my eyes are so dry, I literally can’t even open my eyelids. Once I physically open them, it’s a severe pain that I wish on no one. In your experience, is the issues with the dryness related to the tearing of the eye? It’s weird that my eye seems to have both extremes, dry and tearing. Unfortunately I feel like I’m fighting this all alone. Look forward to your response.
Quick note: I have never had a macrodacrocystogram, but the second ophthalmologist did offer an MRI to show the blockage if I chose so (I assume that’s what he was pertaining to). The last Dr performed a dry eye test, but said my eyes simply weren’t “that dry.” I feel like they always are though, with the exception of the tearing in the one corner.
Hi Mark, I’m so sorry for the late reply. I had 6 comments slip through my wordpress site over the past 12 months and yours was one of them unfortunately. I also deal with a lot of spam. I hope this is not too late.
Yes indeed, dry eyes will cause tearing. I’ve had dry eyes for 8 years and traveled to multiple specialists in two different states and had three failed surgeries. What occurs with dry eyes is the surface of your eyes sends signals to the tear glands to “secrete tears, I’m very dry and need them”…but it doesn’t control the amount of tears sent. It also tears via irritation from the dryness. Artificial tears don’t work very well because they evaporate very quickly (especially if you have Meibomian Gland Syndrome). You require a proper assessment and I think you need to see another, more prominent surgeon who specializes in dry eye. I can certainly recommend you to the best. What state do you live in?
There’s no point having DCR if your tearing is caused by dry eyes. Have you had a saline test to see if saline regurgitates back out of the eye? And the next thing is a macrodacrocystogram to precisely locate where the block is (that’s “if” you have a block at all).
So it’s been a little over a month since you wrote. What have you decided to do and what action have you taken so far? I can provide advice for both dry and tearing eyes and save you a lot of searching.
Sorry again for the late reply. All the very best!
Please let me know who does the balloon thing thanks I would have it done
Hi Don…it seems you maybe in the UK. It’s not possible for me to have a list of surgeons who performs the balloon dilatation. It’s a very big world!! These surgeons need to be located by yourself. What I always suggest is to make a list of all the eye surgeons in your country and phone them. Ask reception if their surgeon will perform balloon dilatation and/or use a stent for a blocked tear duct. Explain how important it is for you to avoid DCR surgery and that you’re willing to accept it’s not as high success rate compared to DCR.
Personally, I’d rather an “improvement” of symptoms compared to living with complications of DCR surgery.
Hi there
I have been told to do the DCR as well. I’ve been to 3 Specialist, the first one gave me different aye drops which didn’t help at all. Second one suggested DCR. Went to the third one for the second opinion. He also confirmed that I need DCR done. I’m living with Sarcoidosis and I am using Steroid Nasal Spray for the past 10yrs. He said the blockage has to do with my Sarco. I am scared of this DCR, do you think the other methods will work for me since I have an underlying problem of Sarco?
Hi there, sarco tends to cause inflammation and can block small openings such as the tiny tear ducts that drain tears into the nose. When that’s obstructed tears have no where to go and they back up and start leaking down the side of the nose.
It is possible that after DCR the new hole made could get blocked over again. It happens even without sarcoidosis so you could be extra susceptible. But on the other hand, it may not happen at all. It’s really a change you would have to take.
The alternatives to DCR could be explored. If you can find an eye surgeon to attempt probing the block through with a wire probe. Many refuse to do it, whilst others have no problems with it. Sometimes it’s all you really need. The block may only be very thin and just needs pushing through. Saline isn’t strong enough, it needs to be a wire probe.
All the very best and please do let us know how you get on!
Hi George, thanks for the reply. I did email the Dr requesting him if we can explore other options. I am now confused as to what to do because this tearing is really troubling me.
Please see my Dr’s response pasted below….
Dear Miss Xulu
Don’t be worried about it. It is a very common operation. Yes the bone is removed but most if it grows back! It is not essential bone for any functional purpose. The tube is only temporarily there and I cannot see a problem with that.
There are other operations but I have trained specifically in this surgery and all the other operations do not work! It is a waste of your time and money to have the other procedures. I have tried some of them and there rest of my knowledge is from discussions with experts under whom I trained.
It is your choice with regards to what you have done but there is only one operation that works which is a dacryocystorhinostomy.
Kind regards
Oh that doctor is being a little dishonest in his reply to you. Firstly, the bone does NOT grow back. I’ve seen X-rays of DCR many years later and the hole is still there. Mine is still there 10 years later and it was confirmed with X-ray. If the hole in the skull closed, then you’d start tearing again so they don’t want it to close.
Yes the tube is temporary and when they remove it you have a more than larger diameter artificial tear duct running into your nose. My eye became very dry when they removed the tubing because when I inhaled, the air travelled through the hole they made and onto my eyeball.
He says he has trained mostly in DCR so he knows very little about the other procedures. I doubt he’s read any studies about how effective they are.
A typical response from a closed minded surgeon unwilling to explore less invasive procedures upon a patients request.
I know you are sick of the tearing and want relief. So was I…that’s why I jumped into DCR after 3 surgeons talked me into it. I still regret the decision, and still suffer the consequences.
It’s basically your decision. I will never tell you to get a DCR operation…that’s your choice. It’s a very grey area with so many doctors not willing to head to patients concerns. But there are surgeon’s who will too!! It’s a matter of finding the open minded surgeons which is very difficult to do.
Do let us know what you decide to do. If you go with DCR let us know how your progress is going since it will assist other visitors to this site. Thankyou.
I thank God that I came across your site. I have finally find another Ophthalmologist who is willing to try Probing. Even said himself that it might just what I need to open my blocked Duct. I am waiting for my appointment date. I will definitely come back with feedback.
Thank you so much
Rgs:Nokuthula
Hi, I lost my complete tear duct on June 8, 2005 when the Pitt Bull Dog I loved attacked me in the face and I had a plate replaced between my eyes and a rib used to rebuild my nose as it had gone away over the years which actually he ate the inside and I was young enough to well back to my tear duct WOW IT HAS CAUSED ME SO MANY PROBLEMS NOT HAVING ONE!!! I got infected and fought it for four years until they had to pull my teeth so the infection from eye could drain out so I’ve had so many Jones tubes but they stop working 😢This last surgery kept me in the hospital a week but no one remembered to clean my jones tube which after a few days out I woke to 104 fever and it came from a dirty jones tube right beside where I was operated on but to the point I have a great doctor but scared tissue I think keeps it blocked so I decided to go looking for a doctor who may can figure a way for it to work but I don’t even know if there is anything else out there .
If anyone has an idea please text me at 678-600-5351 and let me know you sent an email ., I just forget to check my email being its a pain to write due to the blurry vision.
Thanks, Paige
Hi George, Thank you so much for this incredibly informative website! Last year June 2017 I was experiencing nonstop tearing in my right eye. I went to an Ophthalmologist and he performed a lacrimal irrigation in my right eye first (didn’t taste the saline) and then on my left to compare (the irrigation went through).
The next day I saw an Occuloplastic surgeon at that same practice and he performed the lacrimal irrigation on just my right eye and it went straight through. He gave me Tobramycin eye drops to treat the infection that was also there. A week later, my right eye was no longer constantly tearing. He told me if it comes back, he would recommend the same irrigation 1 or 2 more times, but after that suggested a Mini Monoka stent.
Fast-forward to May 2018, after living in a new state with the driest climate for 7 months now, the tearing right eye returned. I am freaking out because I am getting married in early 2019 and I cannot wear makeup with my constant tearing and I spend my entire day wiping my eye. I saw a new Ophthalmologist who tried to irrigate it to no avail, then a new Occuloplastic surgeon. He said I may need to do DCR, but first suggested I check if it’s dry eye, and sent me home for a week with artificial tears 4X/day plus ointment at night. It didn’t help and I saw him a week later (yesterday) for an irrigation and it was blocked. He numbed it and tried again with the probe and it failed again. He kept suggesting an External DCR, and when I asked about my previous doctor’s recommendation for a Mini Monoka stent, he told me that only works on children up to 2 years old and not for adults. Even after asking if he could do the Endonasal DCR, he wasn’t thrilled about it and said he doesn’t perform that one unless I go to his other office out-of-state.
Disheartened, I scheduled an appointment with the only other recommended Occuloplastic surgeon in the state and can’t see her until the end of the month. I am so frustrated that I am going back to my original doctor out-of-state in the hopes he will provide me with new information about why he didn’t recommend DCR, but rather Mini-Monoka stent. After reading through all your mentioned alternative options and the comments from thr readers, I didn’t see any mention of Mini-Monoka. Is there something I missed? Is this the balloon option? I will keep you updated here after I see the other 2 doctors regarding the possible treatment recommendations, as I truly do not want to resort to DCR as most surgeons seem to want to only recommend that and the side effects are permanent and I don’t have a lot of time on my side for recovery and healing leading up to my wedding day. I am printing out this page on alternatives and treatments to my next 2 appointments in the hope that I will not be pushed for DCR.
Again, thank you for sharing your experience, I am sorry to hear of all the negative effects it has had on you, but with your help, you have informed us other sufferers of blocked tear ducts with knowledge and alternative options.
Hi Natalie. I’m glad you’ve found the information on my site helpful. I’ve had mini-monoka stents placed into both eyes under general anaesthetic. It was a novel approach by an oculoplastic surgeon to plug up the lower ducts to conserve tears on dry eyes. It was an alternative to punctal plugs or cautery.
It’s ashame you’ve moved interstate and the new oculoplastic surgeon is rejecting use of the stents. It’s rubbish to suggest it’s only used on 2 years olds. The truth is… HE just doesn’t use them on anyone else. I’m certainly not 2, I had it done! Some doctors are just willing to go that extra mile for you. Others want to cut you up and use the most invasive procedures first. Reject their incessant obsession with DCR surgery!
The balloon dilatation technique is a seperate solution to mini-monoka stents. If it’s possible, find a surgeon who isn’t too hard up and will listen to your concerns for non-invasive techniques. Perhaps you could get a probe done to your right eye to clear it out for awhile before your wedding? Then look for something more permanent?
If all else fails and you have no choice. NEVER go for external DCR, which often leaves a permanent raised bump on the nose and massacres the tear gland. Endonasal DCR, whilst still involves a hole drilled through the nasal bone and creates an alternative is still the better option.
Hi George!
Good news and updates! I went to go see my original doctor before I moved out of state, the one who was able to perform the lacrimal irrigation last year successfully, and he succeeded in irrigating my tear duct 2 days ago!
For ::some:: reason the oculoplastic surgeon I went to in my new hometown, the one who only suggested DCR, could not irrigate me (I believe he just didn’t push hard enough to irrigate thus my only option is DCR, yeah whatever).
The good doctor, he told me that the blockage seems to be in the nasolacrimal duct (based on the reaction of mucus coming up after the irrigation) and that the Mini Monoka is recommended only for blockage in the lacrimal sac. I am glad he is able to identify the problem area. He said for my issue he recommends a DCR, external or endonasal. He actually said one of the side effects of the surgery is when blowing your nose, air can come out. Surprisingly, the bad doctor did not tell me this. I knew already as I had read your blog.
The good doctor also offered some alternatives and suggestions. He said although he does not perform the balloon procedure, he will recommend me to the doctor who invented it. He said the procedure is not as successful as the DCR however. For those who are looking for doctors who can perform the balloon procedure, his name is Dr. Bruce Becker in the Los Angeles area (Encino or Westlake Village in California)
http://www.eyelidocs.com/dr-becker/dr-bruce-b-becker/
He told me perhaps the reason of my blockage is some trauma with my nose (which has happened) and to see an ENT to identify if that is the issue (deviated septum). Perhaps that doctor can treat me and my tear duct issues will go away. That is an option I am willing to explore, but again that might involve a nose surgery which scares me! Interestingly, when I mentioned to the bad doctor that perhaps if I fix my nose, my tear duct blockage could go away, he completely dismissed me.
What I would like to point out to anyone else reading this, please make sure you go to a doctor who knows how to properly do a lacrimal irrigation. Some don’t bother trying hard enough, or more than once. The one who irrigated me properly, he didn’t get through at first attempt, but tried again a minute later. I have never been so happy tasting a gross saline solution. Now although this is not a permanent solution at all for me, because it can come back at any time triggered by many factors, it is one I am okay with at least until after my wedding next year.
I am so grateful for this website offering me hope and knowledge of this condition, the procedures and alternatives. Thank you thank you!
Hi LeakyEyeGirl, Can I ask who the good doctor is who was able to irrigate your eye successfully? I have had a few different doctors irrigate it but they haven’t been successful.
Thank you!
Hr Kristen,
Dr. Stanley Saulny is the doctor. He is based in Encino or West Hills in Southern California (Los Angeles area) and looks like also in Austin, TX area if you Google him.
Great to read up so much information as I am caught up with the same dilemma on my left eye. I had the partial blocked tear duct in 2014 and it was treated with a few rounds of syringing/antiobiotic drops/eye ointment/masaging and it worked. However it has resurfaced now after 5 years and this time the syringing hasn’t worked completely and I have been advised Endonasal DCR by the Eye doctor who I felt did not follow aggressive syringing. Although the problem had stopped for two weeks after antibiotic drops/eye ointment as the infection went down, it has resurfaced again. The two ENTs I went to see advised END DCR and as I was looking for alternative treatments, my wife’s homeopathic doctor asked me to do a CT scan of my sinuses and the CT report shows that I have sinusitis in my left side and my problem is also with my left eye, hence her diagnosis is that this is causing the problem, however the ENTs don’t agree as they say I have mild sinusitis. As I have been advised by my main ENT to get my HBAIC levels down from 7 to 6 before he operates I have been trying to find non invasive procedures before that and so far homeopathy seems to be the only option here so far as I am yet to find a surgeon in India who has done balloon dacroplasty in India.If any of you has done this procedure abroad, please do let me know as I don’t mind visiting him. I am also trying the Eye Surgeon who treated me in 2014 to do more aggressive syringing to see if it works as he was not available when I had the issue this time. However what I find strange is that none of the eye doctors here nor the ENTs have told me the cause behind the blocked tear ducts and hence they are not treating the cause but finding an immediate solution, which I am not 100% that it will not re occur again. As I see there are patients here who have had DCR or END DCR for a long time, is it 100% successful orcas it re occurred? I will only do it if I am 100% sure, however it is also difficult to work with Chronic Dacrocysititis. So its a catch 22.
I have had extreme dry eyes for many years and I have had a number of different surgeries including repeated PRK, top and bottom eyelid surgeries repeatedly, unsuccessful cataract surgery, punctal plugs, cauterization of punctal area repeated twice, punctal snip, irrigation, probing, etc. Most recently I had cauterization again but it resulted in tears spilling down my face most recently so I had punctal snipping and irrigation to try to reverse the cauterization. It was unsuccessful. Now DCR is being recommended. What are suggested options at this point? I have impaired vision due to having too much tears in my eyes.
Hi Susan, So you’ve gone from dry eyes, and in an attempt to fix it you’ve got teary eyes? I’ve also had bottom cautery but the oculoplastic surgeon was aware that I may want to reverse it in the future. So he used a technique that didn’t go too deep and a tiny drilling tool could easily unblock it. Seems like the punctal snipping didn’t help.
Have you read the other alternatives to use on my site. I don’t ever recommend DCR, it can cause more problems than before you began. Balloon dilatation and using a stent in the naso-lacrimal duct are options to explore. But since you’ve had so much work already, be very careful and chose your surgeon carefully. My journey took me to two different states in Australia, which amounted to a lot of travelling.
Thank you so much for your reply. One week ago, the oculoplastic surgeon put in Monoka tubes in both eyes and grafts inside my lower lids. I still have excessive tearing, but maybe less so than prior to this latest surgery. My right eye is more painful and uncomfortable. Pain began suddenly in right eye five days after surgery. Pain is similar to that which I experienced with corneal erosion but seems to have some very slight improvement after three days since it began, but not completely gone away. I can see the end of the tube in my lower lids and the one in the right eye is not seated as the one in the left eye is. The right eye has more tearing than the left eye and the tears spill onto my face (although not as much as before surgery). I went back to doctor complaining of pain in right eye three days ago and he said there was no problem although he only looked at me from a foot or two away for a few seconds. My concern is that my vision is no better at all and I must mop tears from both eyes in order to try to read something with a magnifying glass. This oculoplastic surgeon has been extremely eager to do DCR all along and keeps repeating that can be done. He only agreed to try puncta snipping and irrigation and now Monoka tubes at my insistence and refusal to agree to DCR. It just seems that the Monoka tubes are not draining enough tears that are there due to the puncta cauterization and these latest surgeries have not successfully overcome the cauterization. In March he reconstructed my lower lids to tighten them in order to prevent so many tears coming down my face but it seems to me that since the puncta snipping done at that time and now the Monoka tubes have not provided adequate drainage of tears, excessive tears are remaining on my eyes and blurring my vision. I have seen so many ophthalmologists and am so frustrated with no relief for so long. Is my only remaining option the DCR? I just want to see without so many tears and pain. I understand that reversal of cauterization is difficult, but so far, the procedures attempted have not resolved the problem of too many tears on the surface of my eye because there is no adequate way for them to drain because the cauterization and scarring are preventing it. I will be extremely grateful for any recommendations at this point or experiences with other patients who have had problems following cauterization.
I just want to say thank you for this blog, I nearly went for DCR because all the Opthalmogist I have seen , tells me that is the only option. I got Sarcoidosis and was on higher dose of Prednisone and my tearing eye stopped. Meaning my its my Sarcoidosis causing the tearing eye, this also means that DCR wouldn’t have solved my tearing eye cause its not a blocked dart but an inflammation caused by Sarcoidosis. Unfortunately, once I was on lower dose of Prednisone, the tearing eye returned. Now I have to beg Opthalmogis to put me on Eye Steriods which they are refusing. They still insist on DCR even when I tell them that Oral Steriods did help
Hi, I have been dealing with what I would call a “leaky” right eye for about 4 months. I had a similar problem about 10 years ago but it disappeared on its own. It would feel “full” and if I pressed my finger at the bridge of my nose and interior of crevice of my eye it would drain – but it was thick and weird. The duct inflamed and was sore so I sought medical attention. My regular ophthalmologist sent me to an occu surgeon where he irrigated the duct and found the top spilled into bottom and vice versa so he deemed I had a complete blockage and said I need a DCR. To my surprise I had to pay my entire deductible of $5,000 so I waited for yearly enrollment at work for a less expensive surgery. In the meantime the blockage seems “better,” it gets aggravated occasionally but for the most part it’s a small and unnoticable bump in the corner of my eye. My eyes are not watery at all but the one eye looks a bit “glassy.” He said i still need DCR. I’m TERRIFIED. The images, stories and the downtime with tubes in my nose and eye and strings hanging out of my nose and eyes and he said I will bleed from my nose and eye for weeks, can’t lay down flat, can’t exercise, can’t work or drive for a week – plus I’m 51 and my skin will not bounce back from a cut in my face like that. I’ve scheduled an appt for a 2nd opinion and thank you for posting this because I’m going to print it up and bring it with me.
Thanks for sharing your experience with us Veroninca, and it’s an experience that is happening way too often, eveyday to hundreds of people.
The glassy eye is probably because it’s slightly more watery or has more tears around it than the other eye.
If you’ve read my alternatives, they are quick and relatively easy but the surgeons avoid them because they only work 70% instead of 90% with DCR. Well, I think 70% is still a good success rate and if it meant they didn’t slaughter my lacrimal system forever…yes it should be the gold standard.
But guess what? They wouldn’t be making $5,000…it would be mere a few hundred dollars.
I went to 4 oculoplastic surgeons and BEGGED them to just probe the blockage or do balloon dilatation or place a stent in it. But they all refused so I was PUSHED into DCR back in 2007, and I STILL have problems due to the surgery all those years ago.
Now, I have a problem with sleep apnea and I can never use a CPAP machine due to having had a DCR surgery. Because it would blow air onto my eyeball consistently due to the hole they drill in the nasal bone. I awake so tired with no motivation or energy due to serious sleep apnea as evidenced from a sleep study I had.
I wish I would have been more persistant and gone interstate to search for a surgeon whom would’ve been open to the alternative. In fact ”after” my DCR I was curious about ‘what if I was more persistant?’ thus I decided to call a few surgeons interstate and the first oculoplastic surgeon I called in Western Australia confirmed he would have performed the alternatives! I was just one phone call away from all this disaster!
I’m your age now, and have gained more wisdom. Look around, be willing to travel, phone all the surgeons you can to avoid DCR and try the more gentler alternatives.
Another note on my comment: The occu surgeon that saw me told me that I need to do a DCR bc the blocked duct could get badly infected and “cause a deep seated infection in your brain and kill you.” Has anyone else been told this?
No, I consulted 4 surgeons and they didn’t mention that. Keep milking it out when it fills with fluid whilst looking for a more compassionate surgeon. They are scaring you into paying them thousands.
In fact, I’ve had two brain MRI scans and it showed fluid in the nasal passages where the DCR was done and it shouldn’t be there. So rather, the opposite could be the case. I get throbbing pain on the temple on the side where the DCR was done. It’s bad enough to take pain killers.
All the very best Veronica, keep in touch and let us know how you get on 🙂
Wow, thank you – he really scared me and yes I keep warm compresses throughout the day and the eye does drain on its own involuntarily. I see a new surgeon this coming Tuesday and my general practioner will be running a bunch of allergy tests for food to see if I’ve been consuming foods that cause me tons of inflammation.
Also look at environmental factors such as fabrics you wear, your pillow, laundry powder, etc they all can cause irritation. Maybe I’m bias because I am a Naturopath, but Naturopaths can offer far detailed tests including environmental, food preservatives, colours, flavourings and food intolerances, etc. There are very powerful herbal formulas that offer strong anti-inflammatory effects. And you could do with a nutrient that helps eliminate excess fluid from the body. Just some of the things a Naturopath could do for you. Doctors don’t have all the answers and some can make you sicker.
I was put on Gabapentin by a sleep doctor to improve my insomnia. But it aggravated depression, and made it much worse. A horrible feeling. So I researched the drug and discovered, a very common side effect is Depression and Suicidal ideation! And the doctor knew I was already taking an anti-depressant. This is just one example! Hundreds of thousands of people die each year due to pharmaceutical drugs (do a google search on it and you’ll soon see the evidence).
Thanks so much for your insightful suggestions prior to entertaining a DCR. My problem began two years ago(I am 83) in right eye. It infected. the ophthomologist gave me anthobiotics. Infection cleared and he was able to successfully administer the saline solution. Year later. Same problem and treatment but saline solution not successful. This summer another eye infection, kind of bad Sent to different ophthomolgist. He treated eye wiith antibiotic(internal) , antibiotic eye drop(2 X per day) polymyxin B salve. Infection cleared it seems. he did saline solution and appears it did no work again. I am scheduled for DCR right eye in early October, 2021. He did not perform any imaging to determine where blockage is in the duct, no mention of balloon dilation, After reading your comments and suggestions and those of patients, I am not certain I should proceed now with DCR. I am located in San Francisco so there are a multitude of specialists at Sutter, CPMC Stanford. Thanks so much. What would you suggest?
Another alternative to DCR surgery is to have Botox injected into the Lacrimal Gland, which is what produces the tears. The Botox will reduce the amount of tears produced. It will help for 4-6 months. Numbing drops will help with any discomfort. In my opinion it is better than irreversible DCR surgery and it’s many risks and possible failure. I went to an award winning doctor for DCR surgery and wasn’t told of all the risks, complications and even the undesirable effects of a “successful” surgery. After a failed 1st surgery and complications from the 2nd surgery, I am full of regrets. Try everything before having DCR surgery.