Summary
Tears drain into the nose via a small system on each side: two puncta (drainage holes), a short canaliculus in each eyelid, and a shared common canaliculus that empties into the lacrimal sac. Watery eye can come from a problem at any of these points, and surgery for each is different from a standard DCR.
Who is this for?
Common indications include:
- narrow or stenosed puncta: corrected with a small in-clinic punctoplasty,
- canalicular blockage after radiotherapy, chemotherapy or chronic infection,
- complete blockage of the upper system: typically requiring a Lester Jones bypass tube,
- post-traumatic canalicular injury that has scarred shut.
A precise diagnosis from a lacrimal assessment is essential before surgery is recommended.
What the procedure involves
There are several procedures, chosen by site of blockage:
- Three-snip punctoplasty: a 5-minute in-clinic procedure under local anaesthetic to enlarge a stenosed punctum.
- Canaliculoplasty with intubation: opening up a narrowed canaliculus and stenting it with a Mini-Monoka or Crawford stent.
- Conjunctivodacryocystorhinostomy (CDCR) with Lester Jones tube: a small glass tube placed at the inner corner of the eye, bypassing the entire drainage system and draining tears directly into the nose. Performed under general anaesthetic.
Recovery and what to expect
- Punctoplasty: minimal recovery, antibiotic ointment for a week.
- Canaliculoplasty: mild bruising; stents in place for 3–6 months.
- Lester Jones tube: a recovery similar to DCR, plus a daily sniffing/care routine.
Risks and alternatives
Risks include displacement or extrusion of the stent or tube, recurrence of the blockage, infection, and a feeling of a foreign body around the inner eye. The Lester Jones tube is the only reliable solution for complete upper-system obstruction.