Canalicular and Tearing Considerations

  • Chapter
  • First Online:
Plastic Surgery of the Lower Eyelids

Abstract

Integral to lower eyelid surgery is consideration of tearing and the lacrimal outflow apparatus. Understanding nasolacrimal apparatus anatomy and function allows for the correct treatment of medial eyelid pathology. Medial eyelid malposition can lead to tearing due to poor apposition of the puncta to the tear lake, while punctal stenosis can impair tear entry to the lacrimal outflow system. Proper assessment and management of the tear drainage apparatus is important in any patient undergoing medial lower eyelid surgery with or without epiphora symptoms. This chapter details tear drainage considerations in lower eyelid surgery.

Illustrations by Michael Han

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Sevel D. Development and congenital abnormalities of the nasolacrimal apparatus. J Pediatr Ophthalmol Strabismus. 1981;18(5):13–9.

    Google Scholar 

  2. Saude T. Ocular anatomy and physiology. Oxford, UK: Blackwell Scientific Publications; 1993.

    Google Scholar 

  3. Kominami R, Yasutaka S, Taniguchi Y, Shinohara H. Anatomy and histology of the lacrimal fluid drainage system. Okajimas Folia Anat Jpn. 2000;77(5):155–60.

    Article  CAS  PubMed  Google Scholar 

  4. Hartstein ME. The Complete Guide to the Evaluation and Management of the Tearing Patient. American Academy of Ophthalmology Annual Meeting. Dallas, TX. October 2000

    Google Scholar 

  5. Eagle R. The eyelid and lacrimal drainage system. In Eye Pathology: An Atlas and Text. Philadelphia: LWW; 2011. p. 241–242.

    Google Scholar 

  6. Singh AD, McCloskey L, Parsons MA, Slater DN. Eccrine hidrocystoma of the eyelid. Eye (Lond). 2005;19:77–9.

    Google Scholar 

  7. Nowinski TS, Anderson RL. The medial spindle procedure for involutional medial ectropion. Arch Ophthalmol. 1985;103(11):1750–3.

    Article  CAS  PubMed  Google Scholar 

  8. Czyz CN, Wulc AE, Ryu CL, Foster JA, Edmonson BC. Caruncular fixation in medial canthal tendon repair: the minimally invasive purse string suture for tendinous laxity and medial ectropion. Ophthalmic Plast Reconstr Surg. 2015;31(1):34–7.

    Google Scholar 

  9. Prendes MA, Jian-Amadi A, Chang SH, Shaftel SS. Ocular trauma from dog bites: characterization, associations, and treatment patterns at a regional level I trauma center over 11 years. Ophthalmic Plast Reconstr Surg. 2016;32(4):279–83.

    Google Scholar 

  10. Baylis HI, Axelrod R. Repair of the lacerated canaliculus. Ophthalmology. 1978;85(12):1271–6.

    Article  CAS  PubMed  Google Scholar 

  11. Rumelt S, Remulla H, Rubin PA. Silicone punctal plug migration resulting in dacryocystitis and canaliculitis. Cornea. 1997;16(3):377–9.

    Article  CAS  PubMed  Google Scholar 

  12. Wang M, Cong R, Yu B. Outcomes of canaliculotomy with and without silicone tube intubation in management of primary canaliculitis. Curr Eye Res. 2021;46(12):1812–5.

    Article  CAS  PubMed  Google Scholar 

  13. Caesar RH, McNab AA. A brief history of punctoplasty: the 3-snip revisited. Eye (Lond). 2005;19(1):16–8.

    Article  CAS  PubMed  Google Scholar 

  14. Carrim ZI, Liolios VI, Vize CJ. Punctoplasty with a Kelly punch. Ophthalmic Plast Reconstr Surg. 2011;27(5):397–8.

    Google Scholar 

  15. Dohlman CH. Punctal occlusion in keratoconjunctivitis sicca. Ophthalmology. 1978;85(12):1277–81.

    Article  CAS  PubMed  Google Scholar 

  16. Ohba E, Dogru M, Hosaka E, Yamazaki A, Asaga R, Tatematsu Y, Ogawa Y, Tsubota K, Goto E. Surgical punctal occlusion with a high heat-energy releasing cautery device for severe dry eye with recurrent punctal plug extrusion. Am J Ophthalmol. 2011;151(3):483-7.e1.

    Article  PubMed  Google Scholar 

  17. Maamari RN, Custer PL, Neimkin MG, Couch SM. Medial canthoplasty for the management of exposure keratopathy. Eye (Lond). 2019;33(6):925–9. https://doi.org/10.1038/s41433-019-0347-9.

    Article  PubMed  Google Scholar 

  18. Fante RG, Elner VM. Transcaruncular approach to medial canthal tendon plication for lower eyelid laxity. Ophthalmic Plast Reconstr Surg. 2001;17(1):16–27.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cameron B. Nabavi .

Editor information

Editors and Affiliations

1 Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (MOV 70477 kb)

Supplementary file2 (MOV 105880 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Nabavi, C.B., Mueller, A.J. (2023). Canalicular and Tearing Considerations. In: Tao, J.P. (eds) Plastic Surgery of the Lower Eyelids . Springer, Cham. https://doi.org/10.1007/978-3-031-36175-3_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-36175-3_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-36174-6

  • Online ISBN: 978-3-031-36175-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Navigation