Surgical treatment of watery eye
Over the decades watery eye caused by nasolacrimal duct obstruction was considered to be incurable. Conservative therapy of this pathology is practically ineffective.
For a long history of watery eye problem, proposed were a great number of different surgical methods of impaired patency recovery.
Among the most popular recent operations on the territory of Ukraine is dacryocystorhinostomy.
What is dacryocystorhinostomy?
Its aim is to reconstruct lacrimal passages by means of elaboration of alternative aperture in nasal cavity. During the operation a cut of skin is made in the projection of the lacrimal sac, limited resection of the lacrimal sac is carried out and rhinostomic apertura in the middle meatus is formed with subsequent suturing of the operative wound.
However, this method is considered to be complicated, staged and quite traumatic. Cosmetic effect is rather bad. The operation efficiency is about 65 percent.
We are looking for an alternative…
In recent decades series of new reparative operations on lacrimal passages were proposed on the ground of implementing the microsurgical technique. The main task was to reduce injury of the operation in the course of tear patency restoration.
Microdrainage of nasolacrimal duct belongs to such methods.
Microdrainage – principle of the method.
As opposed to dacryocystorhinostomy, in the process of microdrainage the apertura is also formed in the middle meatus through the wall of the lacrimal sac, but it is done through the lacrimal ducts. Consequently, much lower injury and better cosmetic effect are achieved.
During the operation silicone seton is left in the lacrimal duct lumen for a significant period of time. Through fissures between separate threads of the seton a tear can go freely into the nose immediately in postoperative period. Intubation of rhinostomic apertura with silicone seton lasts 3 months. Afterwards threads wash themselves.
What are the advantages?
Use of silicone seton for short-term intubation of nasolacrimal duct in cases of dacryostenoses, and its attenuated placement do not lead to postoperative inflammatory complications, cease lacrimation for the period of drainage, have a high degree of recovery and substantially shorten duration of the operation as well as postoperative recovery.
The results are much better!
The best results of microdrainage are achieved in case of congenital defect of lacrimal ducts -100 percent of cure. In case of lacrimal points pathology, cure results reach 92 percent, in case of tearing due to trauma of lacrimal ducts and anatomic lacrimation – 75 percent.
Owing to low injury rate and simplicity, microdrainage belongs to ambulatory operations. It lasts 15-20 minutes.
Microdrainage is performed if nasolacrimal duct obstruction is persistent. Before microdrainage, a surgeon uses such methods as intubation of nasolacrimal canal and bougienage.