Problems with tear secretion are the most common cause of dry eyes. Tears are mainly produced by the tear gland, which is located in the upper-outer part of the eyeball, and while moisturizing the eyeball, it keeps the eye clean and clear. With each blink, the produced tears are spread on the surface of the eye and the excess amount is entered into the nose through the duct after washing the surface of the eye and is continuously emptied by this device.
Normally, there are two channels in each eye for tears to escape: one in the upper eyelid and the other in the lower eyelid. Tears flow through these ducts into the tear sac, which is located in the inner corner of the eye and next to the root of the nose. Tears then enter the nose through the nasolacrimal duct. If the duct is blocked for any reason, tearing will be difficult. Because the tears do not drain completely, a mucosal infection can begin. As a result, the eyelids and around the nose become swollen, red and painful.
Some of Symptoms for Tear Duct Obstruction:
Tear duct obstruction is a common phenomenon in children and infants. In infants in 5% of cases and in premature infants up to 30% of cases, tear duct obstruction is observed at birth. These children usually recover spontaneously in 90% of cases by the age of 8 to 9 months, and if they do not improve spontaneously, tear duct catheterization is performed after this age. If the catheterization is performed under the age of one, the probability of success is over 90%. The higher the age at the time of catheterization is, the lower the probability of success will be.
Children 4 to 5 years of age usually require Tear duct obstruction surgery with silicone tube implantation. Tear duct obstruction can be treated only at the age of two to three years with tear duct catheterization. But in older age, catheterization is only diagnostic and is not recommended for treatment.
Blocked Tear Duct are less common in adults. In adults, a procedure called a Dacryocystorhinostomy (DCR) is performed, which opens the tear duct into the nose. Now, if the initial part of the duct is closed, in addition to DCR, the silicone tube should be placed for several months; but if the end is closed, only DCR is enough.
Tear duct stenosis with tear in adults may be caused by:
Diagnosis is made by a physician based on the examination and clinical signs mentioned. Substances such as fluorescein are injected into the eye, and the presence or absence of obstruction can be judged by the time they disappear from the eye or the time they are present in the oral cavity (assessed by cobalt blue light). Sometimes a radiograph, called a dacryocystogram (DCG), is needed to diagnose narrow or blocked tear ducts.
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Surgery called Dacryocystorhinostomy (DCR) is the solution for this problem and is performed under the supervision of a plastic eye surgeon with general or local Anesthesia. In 95-85% of cases in children less than one year is successful, but with increasing age, the probability of success decreases. Probing is a surgical procedure that takes about 10 minutes and a thin metal probe or skewer is passed through a closed tear duct to remove the obstruction. Usually, Dacryocystorhinostomy (DCR) surgery in children and infants is under local anesthesia and is performed in day clinic and there is no need to stay a night.
In adults, the surgical procedure is to make a small incision in the area between the eyes and the nose, on the skin of the outer part of the nose, to reach the tear sac. A small piece of bone is then removed between the lacrimal sac and the nose. At this stage, the tear sac is cut and the cutting edges are sewn to the inner mucosa of the nose in such a way that there is a direct connection between the tear sac and the nose. Usually during this operation, a silicone tube is temporarily inserted into the duct to prevent re-obstruction of the duct after surgery. This tube is painless and does not cause any problems for the patient.
Endoscopic tear duct surgery is performed with the same purpose as the previous method, with the difference that here the surgery is performed from inside the nose using an endoscope and some small instruments. This method is now more common because it leaves no scars and is generally less painful than the previous method. In this method, the location of the tear sac is first determined based on extensive studies performed on the anatomy of the patient’s face with tearing eyes. The bone is then removed from the tear sac and the sac opens into the nose. Some surgeons prefer to place a stent in the patient’s nose for a while to keep the opening open. The pain of the endoscopic procedure for tear drop is very low and can be controlled with acetaminophen and mild prescription painkillers. Infection is rare, however many surgeons prefer to use antibiotics after surgery. Bleeding is usually very small. Endoscopic tear duct surgery success rate is generally more than 90%. Endoscopic DCR surgery does not require the patient to get hospitalized for the treatment and it provides a much desirable aesthetic look as there is no visible scar formation after the procedure.
Tear Duct surgery lasts about an hour and is usually performed under local anesthesia with sedation or under general anesthesia depends on surgeon diagnosis. The patient needs to stay at hospital overnight.
Postoperative care after Dacryocystorhinostomy (DCR) surgery
Top-rated and proficient eye surgeons in Iran are what we are proud of. Without doubt, when positive result happens by experienced surgeon and specialized hospitals, clinics, and eye centers in one hand and affordable price -high quality laser eye surgery on the other hand, Iran can be chosen as the preferred place for dacryocystorhinostomy. Each month, more than 42,000 Iranian and foreign patients are going under DCR in Iran. DCR in Iran is on top of the middle-east regarding its skilled specialists and surgeons.
Also, following government’s perspective, majority of clinics and hospitals have been internationally standardized and equipped in recent years. So the patient’s need of security and safe condition will be truly met.
In terms of costs, Iran can be considered among the most affordable countries in which you can have eye surgeries, especially; this is mainly because of the low value of the Iranian currency (IRR). Because of large number of DCR clinics and large number of applicants for DCR in Iran, there is a significant difference between the cost of DCR in Iran and other countries.
Blocked Tear Duct’s cost for infants varies among 200$ to 650$ because it is not a complicated process. On other hand, DCR (Dacryocystorhinostomy) cost for adults in Iran is more affordable than anywhere in the world. In terms of costs, there is a dramatic difference between Iran and other countries. Although, the experience, level of expertise, and qualifications of the surgeon, the type of surgery, clinic, anesthesia, related services such as post-op recovery and follow-up, and the surgeon’s reputation may effect on total cost, but; the average eyelid surgery cost in Iran ranges from $950 to $1800. In compare to this operation costs in other countries minimum: about 3500$ globally, in USA or Canada about 4000 $, In Europe about 3300$, Iran can be considered among the most affordable countries. It goes without saying that a typical DCR surgery, which is actually quite common in Iran, costs around $2,500 in neighboring countries.
It should be noted that individual brochures based on the patient / client plan, including pre- and post-operative instructions, as well as the necessary information and processes for further follow-up are provided to you. During your stay in Iran, the translators of Nora Health Tour fully support you 24/7 and will happily help you to resolve any concerns or ambiguities that may arise for you.
DCR surgery is a procedure that is used to treat blocked tear ducts in adults and aims to eliminate fluid and mucus retention within the lacrimal sac, and to increase tear drainage for relief of water running down the face.
The operation usually takes about 1 hour.
You may need a DCR because a part of the tear drainage system of your eye (the lacrimal system) is blocked and so the tears are not draining away as they should. You are likely to have the following symptoms:
One week postoperative the sutures are removed, oral medications discontinued, topical steroids are tapered and nasal medications continued for two more weeks. The patient is reviewed at 6 weeks, 12 weeks, and 6 months. If the patient is intubated then tube removal is usually done at 12 weeks.
If there is a blockage in this system the eye can start watering and you may be more prone to infections.
The main complications after surgery are bleeding and infection. Usually this is a small amount and resolves within 48 hours.
In most cases, your procedure will be performed under general anesthesia. The procedure generally lasts 1-1.5 hours but may vary for any given patient. The time that the patient will be away from their family members travelling to the operating room, going to sleep, awakening from anesthesia, and recovering from the procedure will add several hours.
The external procedure is approximately 95% successful with 95 out of every 100 patients having complete relief of their symptoms. The endonasal approach is approximately 85% successful 85 out of every 100 patients having complete relief of their symptoms.
There are there no alternatives to this form of treatment.
The operation can take approximately 45 to 60 minutes and is performed under a general anesthetic.
We will give you an appointment to return for a checkup in approximately 6 weeks’ time. Your appointment letter will be given to you before your discharge home.
You may have some bruising or swelling around the operation site or around the eye.
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