Blocked Tear Duct

[SueRL]

I have been reading more posts on this forum after I wrote my first one earlier today.
In regards to a blocked tear duct, which or what is the usual order of treatment after
irrigation and antibiotic drops?
I read the Jones tube is to be after 3 failed operations.  Is this to mean 3 failed DCR's?
Has anyone here had the endoscopic version of the DCR?  Or laser assisted DCR?
I am not sure I understand the laser assisted one.
I have heard some folks don't believe this non external ones are effective.
Please, any help, or any thoughts.
Sue

[John C Hagan III, MD, FACS, FAAO]

top part equal- openings on inner aspect of upper and lower lids (puncta), upper and lower tear ducts, common tear duct, tear sac, lower tear duct, valve of Hasner where it goes into the nose.

JCH MD

[SueRL]

I am a RN and am trying to understand the physiology of the lacrimal system.  

Would it be correct to say that the lacrimal sac is the  top of the lower system?

I promise not to have many more questions.

Thank you,
Sue

[John C Hagan III, MD, FACS, FAAO]

What I was saying is that after 3 or 4 failed DCRs you do not go to a Jones tube if the problem is the lower tear system.  Jones tubes are for failed upper drainage systems and DCRs for lower system failrure.

Go to Google images and type in tear duct system for a picture of what the drainage "pipes" look like.

A Jones tube IS a permanent stent.  In a DCR a stent such is sometimes place in the nose to keep the system from scarring down. it is normally removed after days to weeks.

JCH MD

[SueRL]

I am sorry.
I am so excited I misspelled your title, I sent off the note so quickly.
Sue

[SueRL]

Thanks so much for the quick response.

Could you please explain what a 4 or 5h DCR ostium means?
Does that have anything to do with the creation of the new duct?
Is a stent used?
I am so glad I found you.
Thank you,
Sue

[John C Hagan III, MD, FACS, FAAO]

If the upper part of the tear drainage system is damaged or badly deformed then a DCR will not work and a Jones tube procedure is done first. Also if the upper system is okay and the problem is that the DCR keeps blocking off in the lower system then the Jones tube is not necessary and a 4 or 5 th DCR ostium revision would be in order rather than Jones tube.

Many ocuoplastic surgeons due the DCR internally using endoscopic techniques within the nose rather than the classic external DCR with incision into the nose from the lower lid.

I believe the laser is used to cut and cautherize tissue.

JCH MD