The Lacrimal System consists of two parts:

The First is the one that secretes the tears. It consists of:

·         Main Lacrimal Glands: located in the upper lid and secrete the tears under strong emotional circumstances such as crying or feeling physical pain.

·         Secondary Lacrimal Glands:  many small glands located in the margins of the upper and lower lids. They secrete water part of tears which constantly keeps the eye moist.

The Second is responsible for the drainage of tears. It consists of:

·         Lacrimal Puncta: Two small openings on the nasal margin of the upper and lower eyelid. They are connected to the lacrimal sac through small tubes.

·         Lacrimal Sac: the place where the tears accumulate and drains into the nasal cavity via the lacrimal duct.

·         Lacrimal Duct:  is a tube though which tears drain from lacrimal sac into nasal cavity.  This causes the nose to run when crying.

Causes of tearing

·         Foreign body Sensation such as dust on the eye surface.

·         Exposure to an injury.

·         Dryness of the eye surface.

·         Emotional triggers such as sadness or happiness.

·         Congenital or acquired lacrimal duct obstruction.

·         Lacrimal duct obstruction due to an infection.

Signs and Symptoms

·         Excessive tearing.

·         Blurred vision.

·         Recurrent infections of the lacrimal sac.

If not properly treated, the symptoms may increase causing a swelling, redness and pain in the inner nasal corner of the eyelid.

Treatment

·         Massaging (for Congenital Obstruction):

Daily gentle massage at the eye corner on the top of the lacrimal sac may help keep the lacrimal puncta and duct open. Pressure on the lacrimal sac increases the sac pressure causing all fluids and mucus to flow downward and open the blockage.

Probing of the Lacrimal Duct

·         Children

If the lacrimal duct obstruction is not improved after one year of birth, this indicates that there are some adhesions inside. In this case, probing should be performed. This procedure is done by inserting a probe inside the duct trough the puncta to clear the duct from adhesions so that the blockage resolve allowing tears to pass. A silicon tube may be inserted in the lacrimal duct to keep it open .After 3 to 6 months the tube will be removed. This procedure may be performed many times in long intervals.

·         Adults

Some patients may benefit from probing, but most patients will need Dacryocystorhinostom, where a skin incision will be made around 1 cm at the side of the nose, and part of the bone will be removed to create a passage between the canaliculi and the nose. A silicone tube will be inserted in the lacrimal duct to keep it open. After a specified period around 3 to 6 months, the tube will be removed non-surgically.

Surgical Opening of the Lacrmial Punctum

 The lacrimal punctum is surgically reopened through simple surgical procedure by making an opening in the nasal corner of upper or lower eye lids. Then the lacrimal duct is reformed opened. The patient recovers in a short time.