Watery eyes may seem like a minor inconvenience, but persistent tearing can disrupt vision, cause irritation, or signal an underlying problem. Relief is possible with specialized care.
Tear duct dysfunction is a common yet often overlooked condition. It can result in chronic tearing, blurred vision, or frequent infections that interfere with daily comfort. Dr. Nina Boal, a board-certified oculofacial plastic surgeon and ophthalmologist, specializes in diagnosing and treating the full spectrum of tear drainage disorders.
With extensive experience in tear duct anatomy, Dr. Boal offers both surgical and non-surgical options tailored to the root cause of your symptoms, not just the surface effects. Her approach combines advanced surgical training with a commitment to functional, minimally invasive solutions.
About Tear Duct Abnormalities
The tear drainage system includes tiny openings in the eyelids (puncta), channels (canaliculi), and the nasolacrimal duct, which drains tears into the nose. When any part of this system is blocked or misaligned, tears can back up onto the surface of the eye, causing overflow, blurry vision, or recurrent infections.
Causes of tear duct dysfunction include the following:
- Age-related narrowing or collapse of the tear ducts
- Chronic inflammation or infection
- Trauma or facial surgery
- Congenital issues in children or adults
- Tumors or growths near the tear drainage system
Accurate diagnosis often requires specialized imaging and testing to identify the location and extent of the blockage.
What Are the Benefits of Dacryocystorhinostomy (DCR)?
DCR is a safe, effective tear duct surgery for nasolacrimal duct obstructions. It offers long-term relief from tearing with minimal disruption to surrounding tissues.
It can be done in 2 different ways: either endoscopically with no visible scarring (done in Center City at Jefferson) or through a small external eyelid incision hidden in your eyelid crease (done at the Montgomery Surgery Center in Lansdale).
Endoscopic DCR Treatment Experience
Endoscopic DCR is typically performed under general anesthesia in Center City Philadelphia at Thomas Jefferson University with our ENT (Ear, Nose, and Throat) colleagues. The procedure generally takes 60 minutes and sometimes may include additional nasal procedures (such as septoplasty) if needed.
The procedure involves the following basic steps:
- The nasal cavity is prepared and anesthetized.
- A tiny endoscope is inserted to visualize the blocked duct.
- A small surgical opening is created to bypass the blockage.
- A soft stent is placed to support healing.
- The nasal cavity is gently packed, and recovery instructions are given.
External/Incisional DCR Treatment Experience
External DCR surgery is typically performed under general anesthesia in Lansdale at the Montgomery Surgery Center. The procedure generally takes 30 to 60 minutes.
The procedure involves the following basic steps:
- The nasal cavity is prepared and anesthetized.
- A small incision ~1.5 cm is made within your natural lower eyelid crease
- A surgical opening is created to bypass the blockage from your eyelid into your nose.
- A soft stent is placed to support healing.
- The incisions are closed with small sutures that dissolve.
- The nasal cavity is gently packed, and recovery instructions are given.
AFTER THE PROCEDURE
Regardless if you chose the endoscopic or external DCR surgery, patients typically go home the same day. Mild nasal congestion, bruising, or tearing is usual for a few days. Most patients return to work within 1-2 weeks. Any temporary stents are removed after 10 to 12 weeks. Full recovery, including resolution of tearing, usually occurs within six to eight weeks.
FAQ
Which surgery -- endoscopic DCR or external DCR -- is better?
Both approaches have similar success rates and many patients are happy regardless of the route they choose. The endoscopic approach will avoid facial incisions and offers a faster recovery, but will require multiple trips to Center City Philadelphia. The external approach is logistically more straightforward, performed in Lansdale, and an equally effective surgery.
Will I have a scar?
When performed endoscopically, DCR is performed entirely through the nose, leaving no external scar. The external approach to DCR will have a small incision that hides within your lower eyelid crease. The incision tends to heal very well and will fade with time.
Is the procedure painful?
Discomfort is typically mild and short-lived. Most patients describe it as nasal pressure or congestion, manageable with over-the-counter or prescribed medication.
Are there risks?
Risks are low but can include bleeding, infection, or failure of the new drainage path to remain open. These are minimized in experienced hands.
Can I combine this with other procedures?
Yes. DCR may be combined with eyelid or sinus procedures, depending on your needs.
