Tears are produced from the lacrimal gland, which sits under the upper eyelid, by the outer part of the eye socket. They are spread over the eye, keeping it moist, when the eyelids close. The tears then drain out through the lacrimal drainage system. The first part of this is the lacrimal punctum, the very small hole on the inner part of the upper and lower eyelids. As the tears collect more at the lower lid, the lower lid punctum has an important part to play in the efficient drainage of tears.
If the punctum is narrow, then it may be necessary to enlarge the opening with surgery. This procedure is called a punctoplasty and consists of making some tiny incisions around the punctum to keep it permanently bigger. The operation is carried out once the eyelid has been numbed with a local anaesthetic injection. It is a simple outpatient procedure that takes 10 -15 minutes to perform. There may be a little bruising of the eyelid afterwards and the inner corner of the eye may be gritty for a couple of days. Antibiotic drops are used afterwards for a few days to make sure the eyelids remain free of infection.
Rarely, the punctum is completely closed, either from some form of scarring or the punctum has never been properly formed. In the latter case, it is possible to explore the punctal area but if there is no functioning tear drainage tubing present then more complex surgery may be required.