Definition and Overview

Canaliculotomy is an ophthalmological surgical procedure performed by an oculoplastic surgeon on patients with conditions that affect the functions of the tear ducts including blockage, infection, structural issues, and abnormal growths, among others.

Who Should Undergo and Expected Results

The canaliculus, also known as tear canals or ducts, are located in the eyelid, right in the inner corner of the eye. There are two ducts in the canaliculus, the superior duct, which is connected to the lacrimal sac (the one that produces tears) and the inferior duct. It also has a sphincter, which is made of muscular fibres and regulates the release of tears.

Canaliculotomy is considered to be the ideal surgical treatment for epiphora, a condition characterised by excessive tearing. The mechanism for properly draining the tear film is insufficient in this condition, resulting in the overflow of tears instead of being channelled into the nasolacrimal system.

Other symptoms of epiphora include yellow or white discharge around the eyes, which can cause the eyelids to stick together and swelling or redness around the eyes or the nose, which can cause pain, fever, increased inflammation in the area, or even the formation of pus around the eyes.

Many cases of epiphora are caused by dysfunctions or blockage in the canaliculi, which can only be addressed by surgery. Blocked tear ducts, on the other hand, can be caused by congenital issues that prevented the normal opening of the sphincter-like muscles in the tear ducts, congenital defects in the nasal bone that put pressure on the tear duct, and undeveloped opening on the inner corner of the eyes.

Some studies claim that these blocked tear ducts are hereditary, but can also be caused by injuries to the bones, tissues, and related structures surrounding the eyes.

After a canaliculotomy, the patient can expect to have clear, symptom-free vision once he or she heals from the procedure.

How is the Procedure performed?

A canaliculotomy involves the drainage of blocked tear ducts. This is an outpatient procedure, which means that the patient will not be required to stay in the hospital for confinement and observation.

The patient can be put under general anaesthesia, which means that he or she will be asleep for the whole duration of the procedure and not be able to feel pain or anxiety. The patient can also opt for sedation, which means that he or she will be awake during the procedure but will not feel pain.

For the actual procedure, the surgeon will make an incision on the side of the nose to remove the bone located in the middle of the tear sac and the nose. He will then attach the tear sac’s lining to that of the nose to create drainage for tears.

The incisions will then be closed up with sutures and the stitches can be removed a week after the procedure. The patient may observe raised scar in the area after the surgery, which normally smoothens after several months.

In some cases, the surgeon will insert a clear glass or plastic tube in the inner corner of the eyes leading to the nose, which will serve as a tent to facilitate the proper draining of tears. This procedure is recommended for patients who do not want visible scarring on the face. The tube can be removed two months after the procedure.

Possible Risks and Complications

Risks and complications are rare in canaliculotomy, but a small percentage of patients can experience the following:

  • Scarring on the side of the nose and the lacrimal sac, which can occur months or even years after the surgery. This complication can be surgically corrected.
  • Scarring of the canaliculi
  • Excessive tearing
  • Infection
  • Excessive bleeding
  • Severe nosebleeds

    Reference:

  • The American Society of Ophthalmic Plastic and Reconstructive Surgery

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