APS Aesthetic Plastic Surgery · 2021

Lacrimal Drainage System Problems After Rhinoplasty

Jamshidian Tehrani M, Asadi Khameneh E, Veisi A.

PubMed 32869132 Publisher (DOI)Free full text (PMC)

What this paper says

Of 43 patients referred with watering eyes after rhinoplasty, 10 had permanent damage to the tear drainage system, and 8 of those needed an operation to create a new drainage passage.

Overview

The tear drainage channel runs from the inner corner of the eye down into the nose, close to where rhinoplasty cuts the nasal bone. This case series reviewed records of patients with epiphora, meaning constant watering of the eye, who had a history of rhinoplasty. Patients with permanent epiphora, defined as lasting beyond 3 months or beginning after 3 months, were analysed for demographics, probing and irrigation results, CT findings, nasal endoscopy findings, treatment and follow up.

Sections of note

Case series; the journal assigns level of evidence IV.
Forty three patients with watering eyes and prior rhinoplasty were referred; 10 had permanent drainage system problems.
Mean time from rhinoplasty to first symptoms was 10.3 plus or minus 15.1 months, range 0 to 45 months.
Mean time from rhinoplasty to drainage surgery was 22.2 plus or minus 19.5 months, range 4 to 60 months.
Probing and irrigation showed canalicular narrowing in 4 patients, 40 percent; pus reflux in 4, 40 percent; clear reflux without passage in 4, 40 percent; and partial nasolacrimal duct obstruction in 2, 20 percent.
Dacryocystorhinostomy was performed in 8 patients, 80 percent.
Therapeutic probing with lacrimal intubation was performed in 2 patients, 20 percent.

What it means for a patient

Persistent eye watering after rhinoplasty can reflect real physical damage to the tear duct, not just temporary swelling.
Symptoms began immediately in some patients and up to nearly four years later in others.
Most of these patients required a further operation to restore drainage.
This series counts only patients referred to one clinic, so it cannot state how often the complication occurs after rhinoplasty overall.

Why this paper matters

Tear duct injury is a recognized but rarely quantified complication of nasal bone surgery, and the delay before symptoms appear obscures the link. This series documents the injury patterns and the treatments used. The underlying rate after rhinoplasty remains unknown.

Terms

Lacrimal drainage system: the passage carrying tears from the eye into the nose.
Epiphora: constant overflow of tears down the face.
Canalicular stenosis: narrowing of the small tear channels near the eyelid.
Nasolacrimal duct obstruction: blockage of the tube running from the eye into the nose.
Dacryocystorhinostomy: an operation creating a new opening from the tear sac into the nose.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Background: To report case series of permanent nasolacrimal system problems following rhinoplasty METHODS: The documents of patients with epiphora and history of rhinoplastic surgery were reviewed. The data of patients with permanent epiphora (continued over 3 months or started after 3 months of post-rhinoplasty surgery) and lacrimal drainage system (LDS) problems were analyzed for demographics, the result of diagnostic probing and irrigation, findings of orbital and paranasal sinuses CT scan, abnormalities in nasal endoscopy, treatment, and follow-up data.

Results: Forty-three patients with epiphora and history of rhinoplasty were referred to our clinic. Ten of them had permanent epiphora and LDS problems. In these patients, the mean time between rhinoplasty and initial symptoms of LDS problems was 10.3 ± 15.1 (range, 0-45 months) and the mean time between rhinoplasty and the LDS surgery was 22.2 ± 19.5 months (range 4-60 months). Diagnostic probing and irrigation test revealed canalicular stenosis in four (40%) patients, pus reflux in four (40%), clear reflux without passage in four (40%), and partial nasolacrimal duct obstruction (NLDO) in two (20%) of patients. DCR was performed in eight (80%) patients. Therapeutic probing and lacrimal intubation were performed in two (20%) patients.

Conclusion: A permanent injury of the LDS is one of the important complications of the rhinoplastic surgery that should be managed based on the onset and duration of the symptoms and the location of the injury.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).