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Several strategies can help manage tearing patients
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WAIKOLOA, Hawaii — Epiphora can be attributed to several causes, and certain strategies can be taken to address the problem, according to a speaker here.
If patients describe their status as “tears constantly going down my cheeks,” it can suggest an outflow obstruction, while patient descriptions of intermittent tearing, “looking through tears” or “watery eye” may suggest increased secretion, Jeremiah P. Tao, MD, FACS, said at Hawaiian Eye 2019.
“If you suspect there is a blockage anywhere downstream from the puncta, usually this is illustrated by probing and irrigation testing. If you put fluid in and there’s nothing in the nose and there’s no resistance with the canula, you can reasonably be assured that you have a nasolacrimal duct obstruction,” Tao said.
Age influences the intervention protocol for patients, as pediatric patients should be observed until the age of 1 year and may become better on their own. If intervention is needed, less invasive procedures such as probing should be considered.
Adults usually need surgery and may need to undergo a dacryocystorhinostomy (DCR), which is the bypass of a blocked nasolacrimal duct through an osteotomy, he said.
The success rate of a DCR is not 100%, no matter if it is external or internal. However, a bigger opening for DCR works better and is less likely to close. A patient with a smaller hole can still be symptomatic due to edema or congestion of the nasal mucosa or mucus plug, Tau said.
When DCR is not an option, a Jones tube can be used as a last resort. Patients should be informed that the tube may migrate or experience a biofilm or mucus buildup, but it can be removed if not well tolerated, he said.
Surgeons need to be mindful of the type of incisions used during a procedure. A vertical incision can heal well in a patient with thick skin, fair complexion and prominent nasal bridge, but it can go against one of the “core principles” of hiding scars within the relaxed tension lines of the face, he said.
Endonasal and endoscopic DCR are also options to treat select patients, Tau said. – by Robert Linnehan and Patricia Nale, ELS
Reference:
Tao JP. Lamenting the lacrimal system: Diagnosis and management of the tearing patient. Presented at: Hawaiian Eye; Jan. 19-25, 2019; Waikoloa, Hawaii.
Disclosure: Tao reports no relevant financial disclosures.