Tear Duct Surgery - James S. Linder, MD, PC
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Transcript Tear Duct Surgery - James S. Linder, MD, PC
Upper and lower eyelid
• Blepharoplasty
• Ptosis Repair
Brow surgery
– Entropion Repair
– Ectropion Repair
• Brow ptosis repair
Tear duct
• DCR (re-routing of the tear duct)
• Lacrimal intubation
Orbital surgery
• Fracture repairs
• Tumor removal
• Decompression resulting from Thyroid Disease
Botox
Juvederm
Radiesse
Cosmetic
Eyelid Surgery
St. Francis
Surgery Center
Methodist Germantown Surgery Center
Tri-State Surgery Center
LeBonheur East Surgery Center
Saint Francis Hospital
Methodist Germantown Hospital
Baptist East Hospital
Regional Hospital of Jackson
Skin
to be removed is marked.
Incision is made along the skin markings
on the upper eyelid.
Skin, muscle, and fatty tissue are
removed.
For a ptosis repair, the muscle that raises
the lid is also tightened.
Before
After
Before
After
Entropion Repair
• Is a surgical procedure to fix an eyelid that is
turning back towards the eye
Ectropion Repair
• Is a surgical procedure to fix an eyelid that is
turning outward.
For
an ectropion repair, the lower tendon
at the outer corner of the eye is exposed
and tightened using an internal suture.
For an entropion repair, additional
sutures are placed in the lower eyelid to
help rotate the lid out, away from the eye.
Before
After
After
Before
After
As
we age, the fatty tissue under our eyelids
tends to protrude, and the lids sag.
In order to repair this, an incision is made
either inside the lid to remove the fatty tissue
(transconjunctival blepharoplasty) or
The incision can also be made below the lashes
and extended to the outer corner. This is called
a transcutaneous blepharoplasty. With this
approach, some excess skin can also be
removed.
There
are many scenarios which can
cause a person to experience excessive
tearing
• Eye irritation
• Dry eyes (ironically)
• Lower eyelid laxity
• Blocked tear ducts
The
first two can be treated with drops
The last two may require surgery
The
tear duct is like the drain in a sink, if it
gets clogged, tears will run over the lid and
down the face (epiphora).
•
There a few reasons a tear duct can fail to
drain properly
• The duct can narrow or close due to
• Age (women, generally, have narrower tear ducts)
• Chronic eye infections
• Sinus/Allergy problems
• Chronic use of eye drops and some chemotherapy
• Previous trauma or placement of punctal plugs
• The duct may have a “stone” blocking the
passage.
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Minor
tear duct surgery can be done in
the office with local anesthesia.
These procedures usually involve
removing a foreign body or enlarging the
opening.
This may also involve irrigation of the
lacrimal system.
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Major
tear duct surgery which typically
involves re-routing the tear duct is done in
the operating room under general
anesthesia.
This procedure is called a DCR.
To begin, a small, half inch, incision is made
between the eye and the nose.
A new, internal opening is made between the
tear sac and the inside of the nose, re-routing
the path through which tears drain.
•
•
Lastly, a small, flexible, silicone tube is
placed, and acts as a stint to keep the new
duct open.
This tube is generally kept in place for about
6 weeks and is removed easily through the
nose, in the office.
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For
upper or lower lid surgery
• Bruising generally lasts for 1 to 2 weeks
2 weeks if upper and lower eyelids are done
simultaneously
• Swelling can take a full month to go down, but a
majority of it will decrease in the first week
• For the first 24-48 hours, you should keep ice on
the lids and sleep with your head elevated.
• You will apply antibiotic ointment to the incisions
twice a day, until your post-op appointment one
week after surgery.
• This type of surgery is typically not painful and
pain medication is not usually needed after 1-2
days.
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Tear
duct surgery
• Is similar to the eyelid surgery course
• Bruising and swelling is usually limited to one
side
• There is some additional risk of bleeding from
the nose since part of the procedure requires
work in the nose.
• You would need to be off of any blood thinners 5 to
7 days before surgery, unless otherwise discussed.
• You may need to get a letter from the physician who
monitors this stating that it is fine to be off the blood
thinner.
Some
examples of blood thinners include
Over the Counter
Aspirin
Vitamin E
Ginko
Ginseng
Garlic supplement
Fish Oil
Prescription
Plavix
Coumadin (or Warfarin)
Pradaxa
Aggrenox
Ticlid
Efient
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Although
eyelid and tear duct surgery is
typically safe and uneventful, it is still
surgery. Usual risks include:
•
•
•
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Bleeding, which could affect your eyesight
Scarring
Infection
Asymmetry
Need for additional surgery
Anesthesia – Anesthesia staff will discuss with you before
surgery
If
you did not schedule your procedure on
your initial visit, we will get in touch with you
over the next few days to set this up.
We are generally booked out about two
weeks in advance.
•
•
If you have a commercial insurance (CIGNA,
BCBS, Aetna, United, etc), certain types of
eyelid surgery may require pre-authorization.
This can take up to 4-6 weeks.
Medicare does not require pre-authorization.
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Thank
you for giving us the opportunity
to take care of you.
If you have any questions during this
process, please call the office at (901)
680-1990, and speak to one of our staff
members.