Most people never get to see pathology of the common canaliculus, yet it is the cause of many presentations of watery eye.
The common canaliculus is a well defined structure, and has a very special role, acting like a valve.
It is the opening into the tear sac, but if it is narrowed, one can flush saline into the nose, yet the tear drain is still blocked…it is too narrow to conduct tears.
This patient has had successful DCR surgery, and the canaliculus has scarred shut. Have a look at this image: you can’t see it at all.
So, at surgery, I pass a probe to dilate it up. Eventually, the probe passes through
This is what it looks like.
But just that wont solve the problem. If I stop there, the canaliculus will close up again.
In my next post, I’ll show you how I overcome it.
How to fix a scarred canaliculus
One way to manage this is to excise, but if you cut it out, it will heal by scarring.
Another simpler solution is to stretch the scar over a long period of time.
To do that, I insert not one but TWO tear drain stents, as shown in the image.
They pass in a loop, so there is 4 tubes stretching this common canaliculus open.
One stent has a larger diameter, and I will remove it first, probably at about 3 months.
The other may remain in place for up to 12 months.
WOUND HEALING TAKES 12 MONTHS!
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