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New Balloon Catheter Helps Patients With "Watery Eyes" At New York Eye And Ear Infirmary
Outpatient Operation
Reduces Cost; Is Safer, Quicker
People with eyes that are
chronically and excessively tearing -- and who see life as if through a glass of
water -- can get help with a new, non-invasive surgical technique that uses a
tiny balloon catheter to open up or circumvent their obstructed tear ducts.
Until recently, the 50,000 adults in the United States who have sought relief
each year for the severe form of this condition, called epiphora, have undergone
a one hour surgical operation involving an incision in the side of the nose and
the insertion of silicone tubes to reroute the tears. The tubes remain in the
nose for six months. "With
the introduction of the lacrimal balloon catheter, both infants and older
patients with severely obstructed tear ducts can be in and out of the
office in a very short time span for a procedure that is safe, performed
under local anesthesia, does not involve insertion of silicone tubes and
is dramatically less costly," said Arthur Millman, M.D., an
ophthalmologist and oculoplastic surgeon at The New York Eye and Ear
Infirmary. Dr. Millman has performed the procedure on over 100 patients
and is giving a paper on his experience at the American Society of
Cataract and Refractive Surgeons on April 28, 1997 in Boston. Excessive
tearing affects approximately 500,000 people in the United States
annually, most of whom are infants under two years of age and adults over
the age of 50. About 1 in 20 infants are born with excessively water eyes,
although the condition disappears naturally for 90 percent of them within
a year. Epiphora can lead to infection and pain. Until now, epiphora
required conventional open surgery and a hospital stay, and has a 95
percent success rate. The newer, non-surgical method is done under local
anesthesia for suitable candidates.For infants under two years of age who
retain the condition, Dr. Millman has had a 98 percent success rate in
clearing the tear ducts using the balloon catheter method. For adults with
partial obstruction of the tear ducts, he has had a 90 percent success
rate, with an additional 8 percent of patients receiving some benefit. For
adults with complete obstruction of the tear duct, his success rate is 80
percent.
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How The Balloon Catheter Works
Tears, produced in the lacrimal gland above the eye, wash the eye’s surface and then drain into a tiny opening in the eyelid, called the
puncta. From here, the tears enter into the tube-like lacrimal ducts which begin at the eye’s orbit and empty through an outlet into the base of the nose. In
epiphora, the tear duct tubes are either completely or partially obstructed. In infants, the obstruction is generally a congenital condition, whereas in adults it is attributed to the process of aging. To treat partial obstruction of the tear duct, the surgeon inserts a lengthy, wire-thin balloon catheter through the puncta and down into the obstructed tear duct. Once in position, the "balloon" part of the catheter is expanded to widen the obstructed tube. The process is repeated several times until the catheter is deflated and removed. To treat total obstruction, the surgeon, instead of widening the tear duct, uses the balloon catheter to create a hole in the bony wall of the nose so that tear flow is rerouted. This is done without the need for open-cutting surgery and therefore results in minimal swelling, pain and recovery time.
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