Tear Duct Surgery - James S. Linder, MD, PC

Report

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:
•
•
•
•
•
•
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.

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