Lacrimation
Lacrimation is a problem that concerns a significant percentage of the population at some point in their life. By tearing we mean the brushing of the eyes from tears. Still, tears may roll out of the eye. Lacrimation can be very disturbing as it affects vision, blurring it, especially in reading, driving and TV. Repeated eye wiping creates relaxation of the eyelids. Patients with lacrimation need to have a full evaluation, so that the exact cause can be identified and the exact plan of the treatment can be decided.
Dr. Nikolaos Trakos is President of the International Society of Dacryology and Dry Eye and can diagnose and treat tearing in the best possible way.
Picture of a patient with lacrimation
Picture of a patient with swelling and inflammation of a lacrimal sac
How do tears drain into the lacrimal duct?
Tears are produced by the lacrimal gland, located below the outer 1/3 of the upper eyelid. Each blink of the eyelids spreads the tears on the surface of the eye, transferring them to the inner corner of the eye, where the lacrimal spots from which the tears enter the nasolacrimal duct, which drains the tears into the nose are located. That is why when we cry our nose is runny.
What are the most common causes of lacrimation?
Dry eye caused by blepharitis. Patients often ask how to tear while having dry eye syndrome! This is because the eyelid mebomian glands malfunction and do not produce good quality oil, which we need to protect the evaporation of the water layer of tears. Thus, the surface of the eye is dried, and reflexes a signal to the lacrimal gland causing it to produce too much tear, which cannot be drained, resulting in tearing.
Abnormal position or malfunction of the eyelids: If the position of the eyelids is not correct, the patient will have excessive tearing. Ectropion (the eyelid that does not touch the eye and is turned outward or loose), entropion (the eyelid turning inward), previous trauma, tumors, congenital eyelid defects, are some of the causes of the abnormal position of the eyelids. The cause of lacrimation is a weak or loose eyelid, which is unable to send tears into the drainage canal located in the inner corner of the eye (e.g. facial nerve palsy).Lacrimal duct obstruction – lacrimal drainage system (see video).
If the lacrimal tract is blocked there may be lacrimation, intense painful inflammation of the sac in the inner corner of the eyelids (dacryocystitis), stuck eyelashes in the morning because of the pus that accumulates in the blocked pore and lacrimal sac, and an abscess can be caused to the cornea and perforated it.
Occlusion can be diagnosed by a specialist, who should check the patient by doing a full study of the lacrimal apparatus. The diagnosis of lacrimal duct obstruction is confirmed, the height of the obstruction is determined, and depending on the level of obstruction of the tear drainage system, the patient can be offered proper treatment.If the nasolacrimal duct is blocked, then the treatment of choice is Endoscopic Intranasal Nasolacriocystostomy.
An essential element of any surgical procedure, especially cosmetic surgery, is providing the patient with sufficient time for information.
How is surgery performed to resolve nasolacrimal duct obstruction?
The aim of this surgery is to create a new tear drainage between the lacrimal sac and the inside of the nose with the aim of creating a bypass higher than the level of obstruction of the nasolacrimal duct.
There are two ways to perform this operation. One is the external technique, which is done through an incision in the skin above the nose.
But Dr. Nikolaos Trakos prefers endoscopic intranasal technique which is performed using a microscopic camera which is inserted into the nasal cavity, and is done without incision and without stitches unlike the old external technique. With the creation of the new drainage route, a stent is placed, which is not usually visible, nor does it bother the patient, and which is temporarily placed to keep the bypass open. It is preferable to perform this operation through the nose (intranasal, endoscopic), because the patient after the operation looks like he has not been operated, since there are no incisions or sutures on the skin and the rehabilitation period is shorter. Endoscopic technique is usually performed under general anesthesia. In selected cases, when not suitable for general anesthesia, it can be performed under local anesthesia with intravenous sedation performed by an anesthesiologist. The patient goes home on the same day, has no pain, and has a 95% success rate, which is extremely high. Treatment of the eye that is tearing may be covered by the health insurance company.
Dr. Nikolaos Trakos is President of the International Society of Dacryology and Dry Eye.
Why choose Dr. Trakos
Dr. Trakos’ contribution to the field of anterior segment and cataract surgery, as well as to the treatment of vision problems, has changed the lives of many people by improving their sight and quality of life.
What is the most common cause of obstruction in children?
Congenital obstruction of the lacrimal duct is quite common in children in whom the nasolacrimal duct fails to open into the nose. As a result, tears, mucus and germs cannot be properly cleaned from the eye and drained through the pore into the nasal cavity, and as a result of this, the child will have constant tearing and pinching or glued eyes-eyelids, especially in the morning. 95% of cases of PDA occlusion will spontaneously recede within the first year of life of the child. For children younger than 1 year, patients are trained by the specialist to do a special “massage” in the area above the nasolacrimal duct 4 times a day.
If the child continues to experience tearing after the first 12 months of life, a catheterization of the nasolacrimal duct is performed. This operation is performed under anesthesia and lasts only a few minutes most of the time, and the child usually has no pain afterwards. Nasolacrimal duct catheterization is effective at a rate of 90-95% and is a safe operation. For these few newborns, in which PNF catheterization fails, a second catheterization may be attempted or intubation with special silicone tubules, which should be placed in the nasolacrimal duct until an open tear drain is secured, which takes 3-6 months after insertion of the tubules.
Dr. Nikolaos Trakos has developed the technique of standard catheterization, upgrading it with the use of technology, to endoscogated – assisted probing (catheterization with the help of an endoscope), which has better results. In this technique, an endoscope is used with which the surgeon sees what he is doing, and does not go blindly as in the widespread, old, standard technique.
For cases that have failed and have been sent to Dr. Trako from other countries or medical centers, which need a repeat of the operation, is performed by Dr. Zurich Zurich. Traco pediatric endoscopic ascorinostomy. Endoscopic ascorinostomy is the most modern method, during which a new way of drainage tears without incision and without sutures is created.
Endoscopic ascorinostomy in a child with congenital nasolacrimal duct obstruction referred to Dr. Nikolaos Trakos after having been operated by other doctors without success. In the photo Dr. Trakos with the Anesthesiologist and the young patient 4 years old. The surgery solved the problem successfully.
Below are representative publications of Dr. Nikolaos Trakos in leading scientific journals.
Singh S, Trakos N, Ali MJ. Ophthalmic Plast Reconstr Surg. 2022 Oct 20. doi: 10.1097/IOP.0000000000002289. Online ahead of print.PMID: 36356188
Singh S, Trakos N, Ali MJ. Ann Anat. 2021 Mar;234:151658. doi: 10.1016/j.aanat.2020.151658. Epub 2020 Dec 2.PMID: 33278580
Trakos N, Singh S, Mishra DK, Ali MJ. Ophthalmic Plast Reconstr Surg. 2020 May/Jun;36(3):263-267. doi: 10.1097/IOP.0000000000001528.PMID: 31895730
Lacrimal punctal and peripunctal involvement in calcinosis cutis.
Bothra N, Ali MJ, Trakos N, Naik MN. Indian J Ophthalmol. 2018 May;66(5):720-722. doi: 10.4103/ijo.IJO_1185_17.PMID: 29676330 Free PMC article.
Trakos N, et al. Clin Ophthalmol. 2009;3:681-4. doi: 10.2147/opth.s7790. Epub 2009 Dec 29.PMID: 20054416
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