What is the best solution for a blocked tear sac?

Many people think that most patients with blocked tear ducts simply have no tears and do not have any other problems. In fact, the harmful effects of blocked tear ducts are very large and may also affect the eyes, nose and the entire facial triangle area, which will be troubled by this disease. As a patient, you must intensify treatment in normal times, use nasal endoscopy, medication, microscopic examination and other methods to conduct reasonable diagnosis and treatment.

Treatment

Patients with chronic dacryocystitis are routinely given antibiotics and lacrimal duct irrigation by the hospital's ophthalmology department before surgery to clear the lacrimal sac secretions. The patient took a semi-sitting position, and 1% dicaine was used for topical anesthesia of the lacrimal punctum. 1% dicaine + 1‰ epinephrine cotton pads were used for topical anesthesia of the nasal cavity on the surgical side at a ratio of 1:100000 for 3 times. Then, a No. 7 probe was used to probe the lacrimal duct from the upper lacrimal punctum (from the lower lacrimal punctum when the lower lacrimal duct was blocked). The tear duct probe (located between the inferior turbinate and the outer wall of the nasal cavity) can be seen under the nasal endoscope TV display. Insert a thin copper wire from the water injection end of the tear duct probe and pass it through the probe to the nasal cavity. Take out the copper wire to the outside of the nose under direct vision of the endoscope, then insert the copper wire into the prepared silicone tube and pass it through the silicone tube. Tie a small knot at the lower end and pull the upper copper wire so that the upper end of the silicone tube is aligned with the probe needle. Then, under the nasal endoscope, slowly pull the copper wire upward and withdraw the probe at the same time, introduce the silicone into the tear duct, and lead the silicone tube out from the lower lacrimal point, so that the wing of the silicone tube enters the lacrimal sac (at this time, there is a certain resistance to pulling the silicone tube downward, proving that the wing has been introduced into the lacrimal sac). The double-tube adhesive section of the silicone tube is left in the nasolacrimal duct. Finally, take out the copper wire, cut off the silicone tube outside the lacrimal point and outside the nose, flush the tear duct from the lower lacrimal point, and see the flushing fluid flow from the silicone tube to the nasal cavity, proving that the operation is successful. After surgery, antibiotic eye drops are given, and the tear ducts are flushed with gentamicin and α-chymotrypsin every other day. After one week, the frequency is changed to 2-3 times a week, and after one month, it is changed to 1-2 times a month. The catheter is left in place for 2-3 months before being removed. This procedure has the following advantages:

(1) Under the TV display of nasal endoscope, the surgical field is clear, the operation is simple, and it is convenient for teaching;

(2) It has a wide range of indications and can be used for diseases such as chronic dacryocystitis, lacrimal duct stenosis, and lacrimal canaliculi rupture and anastomosis;

(3) A wing-shaped fixation device is used in the lacrimal sac. Since the spinal anesthesia silicone tube is relatively soft, the wing-shaped fixation device will automatically fold when the silicone tube is pulled up, so it is easy to introduce it into the lacrimal sac. After introduction into the lacrimal sac, the wing-shaped fixation device will naturally open, thereby increasing the support and fixation of the catheter and enhancing the stability of the catheter. Therefore, there is no need for suture fixation, which does not affect beauty and daily life. No catheter dislocation occurred in this group of cases.

(4) The nasolacrimal duct is supported by double tubes. The placement of the tubes conforms to the anatomical and physiological characteristics and requirements of the lacrimal system. It does not affect the normal tear drainage during treatment and there are no obvious symptoms of epiphora. At the same time, it can make the nasolacrimal duct continue to expand, which is beneficial to the drainage of tears and secretions and the disappearance of inflammation.