There are very important components for the cornea in the content of tears such as nutrients, oxygen, growth factors, biological protection factors. In addition, metabolic residues of the cornea and tears that have been exposed to atmospheric pollution must be renewed. With each blink reflex, new tears come to the eye, nutrients are used and contaminated tears leave the eye.
The tear leaving the eye begins with the holes called punctum on the inner edge of the upper and lower eyelids, and goes into the nasal cavity with the canalicular system, lacrimal sac and nasolacrimal duct. The runny nose of crying people (which is the flow of tears) is due to this anatomical path.
The volume formed by the eyelids and the eye surface is like a pool (Adnex). The flow of tears production and drainage (drainage) of this pool is provided by lacrimal ducts. Due to the increase of the mite in the pool (lacrimation), that is, the secretion of reflex tears, there will be overflows in the pool, that is, tears. In this case, stimulant, allergic, mechanical and inflammatory causes should be considered.
The same clinical situation, characterized by overflow in the pool, may also be due to poor drainage (Epiphora). Obstructions in the tear ducts can be mostly due to inflammations involving the intranasal mucosa, canaliculi stones, foreign bodies, intranasal pathologies, previous nasal surgeries, and the use of drugs such as phospholine iodide for a long time.
Whether it is lacrimation (excess production) or lack of drainage (epiphora) that patients have tearing can be detected by dye tests, nasolacrimal lavage, and scintigraphy. If the tears in the patients are due to epiphora, these patients are called chronic dacryocystitis.
In addition to tearing, conjunctivitis is observed in these patients, and a white-colored fluid (mucopurulent regurgitation) is observed when the sac area is pressed. Rarely, acute dacryocystitis attack characterized by swelling, pain, local temperature increase and redness in the localization of the lacrimal sac may also be experienced. Acute dacryocystitis are cleared by systemic and topical antibiotic administration, and sometimes by drainage (draining the abscess). However, the obstruction and the clinical situation it creates do not change.
The definitive solution of chronic dacryocystitis is surgery. The procedure performed is dacryocystorhinostomy (DSR) surgery. This surgery is a kind of bridging surgery. A new path is opened between the closure of the path and the tear sac. The lacrimal sac must be viewed (DSG dacryocystography) in order to determine the bridging site and to understand the condition of the lacrimal sac. Surgery is recommended for eligible patients. The operation can be performed under local anesthesia or general anesthesia. The operation takes 60-90 minutes. 1st day, 15th day, 30th postoperative day checks are required. The success of the surgery is up to 95%. Some patients may also need to insert a silicone tube (intubation). Glass pyrex tubes may also be required for canalicular occlusions.
If the surgery is performed on the appropriate patient with the appropriate method, the probability of satisfactory results is quite high. The patient should be evaluated before surgery, and if there are intranasal pathologies, they should be eliminated first. It can also be done through the skin (external) and intranasally (internal). Both initiatives have advantages over the other. It is necessary to decide according to the patient's condition. DSR surgery is an operation that requires a lot of experience. For this reason, oculoplastic surgeons should be preferred.