If the tear ducts (puncta) are blocked (occlusion), the blockage should be cleared. The cause of the blockage should first be determined.
If the tear ducts were cauterized to retain moisture, it may be time to begin opening the tear ducts. This should be done in conjunction with Schirmer tests to determine how much the ducts should be opened.
If the tear ducts are opened adequately according to Schirmer tests, and epiphora persists, this may due to blockage in the tear duct, or edema (swelling) in the sinuses.
If the blockage is in the tear duct, your doctor will irrigate the duct with sterile saline solution, using a syringe that will clear the blockage. Once the blockage is cleared, you will taste the salty saline solution used to irrigate in the back of the throat.
If it takes more than one syringe to clear the blockage, it is likely that there is swelling in the nasal passages.
Swelling in the nasal passages may be due to allergies which may be treated with oral or topical nasal decongestants, antihistamines, or steroids. If taken orally, the lowest dose possible should be used to avoid impacting lacrimal gland function and causing aqueous deficiency.
Oral nasal decongestants, antihistamines, and steroids may cause discomfort in the eyes. If they cause discomfort, these medications should be discontinued.
If nasal decongestants, antihistamines, or steroids are ineffective, they should be discontinued.
If nasal decongestants, antihistamines, or steroids cause the epiphora to increase, this is a sign that the sprays are causing nasal irritation or allergies, and should be discontinued.
If epiphora persists, even though tear ducts are clear, but treatment with decongestants, antihistamines, or steroids is not an option, an Ear Nose and Throat specialist may need to be consulted. The doctor may order scans of the nasal area to determine the underlying cause of the epiphora. In some cases, surgery may be necessary.
Closed tear ducts that were cauterized deeply may require surgery to reverse the procedure. The risk of returning to a Dry Eye state should be seriously considered, in addition to other surgical risks, because in a new channel created for tear outflow may exacerbate Dry Eye symptoms e.g.: DCR sugery. Surgeries that open tear ducts include:
- Tear duct opening (punctoplasty) – If the punctum (tear duct opening on the eyelid margin) is narrow, a procedure can be done in the office under local anesthesia to open it.
- Tear duct intubation (stenting) – For narrowed but not completely blocked tear ducts (usually related to medication), tubes (or stents) can be placed in the tear ducts for a couple of months to prevent further or permanent scarring. This procedure can be done either in the office or in the operating room under sedation. Tube removal is performed in the office.
- Dacryocystorhinostomy (DCR) – A channel is created between the tear duct and the nose to allow the tears to drain. The procedure is performed in the operating room under general anesthesia and also involves placing tubes (or stents) in the lacrimal ducts for a couple of months. Tube removal is performed in the office.
- Jones Tube placement (cDCR) – A rigid plastic tube (the Jones tube) is placed, after a DCR surgery is performed, from the inner corner of the eye into the nose. This tube will stay in place permanently, although occasionally it needs to be replaced.