Infection of the tear drainage pathway of the eye

Tears from the eye drain into the nose via the tear drainage pathway (lacrimal drainage system). This pathway is like a pipe from the eyelid, which opens into the nose.

Blockage of this pathway leads to excessive watering and discharge from the eye. Collection of this fluid in the system can get infected and present with swelling, redness and pain at the junction of the lower eyelid and nose (Acute dacryocystitis).

This pain is intense and the swelling is red and tense and can extend to involve the entire lower eyelid. There can be pus formation in the area (Lacrimal abscess). Sometimes, the swelling can break open onto the skin leading to evacuation of the pus and formation of a fistula from the tear pathway to the skin (Lacrimal fistula).

In rare instances, the infection can spread backwards and around the eye and cause decrease or loss of vision.

Treatment:

There is a block in the tear draining pathway. The final treatment needed is a surgical procedure (external or endoscopic) creating a new bypass pathway from the eye into the nose.

How do we treat the acute infection?

Treatment involves medical management in the form of oral antibiotics and pain killers. Warm compresses help to hasten the resolution. Once the acute infection subsides, we need to go ahead with surgery to create new bypass pathway.

What if surgery is delayed or not done?

There will be persistent watering from the eye and the chances of having repeat attacks of infection are very high.

Can the surgery be done when there is acute infection?

Surgery can be done during the phase of acute infection provided we do the surgery endoscopically. Infact once the surgery is done, there is complete relief of pain and swelling on the next day, making the person extremely comfortable.

Advantages of endoscopic approach:

1. No cuts on the skin, hence no stitches (sutures)
2. No scar formation on the skin as there are no cuts
3. Post operative recovery is sooner
4. Nasal bleeding rate is much less when compared to the surgery done with external approach

Watch the surgical video – endoscopic approach

What about surgery done using an external approach?

 It can be done after the acute infection resolves. The surgery is essentially the same, whether done endoscopically or using an external approach.

Watch the surgical video – external approach

Which route is better? External or endoscopic?

Both the approaches are equally effective. However, endoscopic approach definitely has advantages over the external route since there are no skin incisions (cuts) and scars, post operative healing is faster and can be done during the acute infection phase.  

For more information, speak to your oculoplastic surgeon.

Nandini Bothra
Consultant, Govindram Seksaria Institute of Dacryology,
Ophthalmic Plastic Surgery Services,
LV Prasad Eye Institute, Hyderabad.
Email id: nan_bothra@yahoo.com