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Orbital/Lacrimal Surgery


The Orbit

The orbit is the bony space surrounding the eyes. It is actually composed of portions of seven different facial bones. Only the surface bones can be felt through the skin. Fat, muscles, and nerves are contained within the orbit and can be affected by a number of diverse entities. Tumors, infections, thyroid disease, inflammation and trauma all can cause damage to orbital structures and create visual problems.

Some people with Grave's Disease, a type of thyroid disease, can develop characteristic bulging eyeballs. Bulging is caused by a buildup of fat in the orbit (eye socket) that can squeeze the eye muscles and eye ball. This can result in redness, pain, swelling, and double vision. In severe cases, vision may be impaired or lost.

Treatment options include:

* Eye drops or oral steroids often can relieve pressure, allowing the eyeballs to relax into the eye sockets.

* Surgery to remove a piece of bone from the side of the eye socket which creates a small reservoir into which the fatty buildup which has been pushing on the eyeball can recede.

It is essential that people with thyroid disease see an ophthalmologist with experience in treating orbital diseases to preserve their vision.


Tear Duct Drainage Surgery

Tears are produced by the lacrimal gland and drain through tiny channels in the eyelids called canaliculi. From the canaliculi, the tears drain through the lacrimal sac and nasolacrimal duct into the lower part of the nose. There can be too much tear production or a blocked tear outflow system. The consequences of excess tearing from a blocked tear duct include persistent blurred vision, tears running down the cheek and chronic red eye.

In order to determine the degree of obstruction and the site of blockage, Dr. Abrams will flush the tear ducts with saline. Flushing the system is a simple in office procedure and causes no discomfort. For some patients there is relief of the symptoms – but for most this is only temporarily requiring additional care. Surgery is necessary to treat those with severe obstruction of the tear ducts, or those who have repeated infections of the system. The operation required is called Dacryocystorhinostomy (DCR), in which a new channel is created to allow tears to drain into the nose again. Specific operations depend on the site of obstruction. A DCR is a ‘same day’ procedure performed at our ambulatory facility.


"DCR" (dacryocystorhinostomy)

For patients with blocked tear duct, the usual cause of a watering eye

The tears normally drain from the corner of the eye close to the nose, via tiny puncta into the very fine lacrimal drainage channels (canaliculi). The tears go into the lacrimal sac, then down the nasolacrimal duct which lies in a bony canal, then opens into your nose. You are not aware of the tears draining into your nose and these go down into the throat.

The most common cause of watering eyes is a blocked nasolacrimal duct. Surgery to overcome this blockage is called "dacryocystorhinostomy" or DCR.

In order to confirm the site of the obstruction causing the watering, lacrimal syringing and gentle probing is done.

The aim of this operation is to relieve a watery, sticky eye caused by blockage of the tear duct (nasolacrimal duct) situated between the tear sac (lacrimal sac) at the corner of the eye and the tear outflow passage into the back of the nose.

DCR consists of creating a direct connection between the tear sac into the nose, bypassing the blockage and allowing tears to drain normally again. Usually some soft silicone tubes are placed, which are removed about two months after surgery.

There are two methods of doing this:

  1. Externally (from the outside, via a short skin incision)
  2. Internally (from inside the nose: endonasal endoscopic)

Why Choose CEI?

Coastal Eye Institute (formerly Manatee Sarasota Eye Clinic) is one of the area’s largest ophthalmology practices featuring a comprehensive team of fellowship-trained ophthalmologists in every subspecialty of eye care.From infancy to the golden years...we provide care for the total health of your eyes. Trust your eye care to our specialists!


Coastal Eye Institute has fellowship-trained ophthalmologists in every specialty of eye care:

  • ➢ Laser Cataract Surgery
  • ➢ Glaucoma
  • ➢ Macular Degeneration
  • ➢ Diabetic Retinopathy
  • ➢ Dry Eye Disease
  • ➢ LASIK Laser Vision Correction
  • ➢ Neuro-Ophthalmology
  • ➢ Pediatric Eye Care
  • ➢ Routine Eye Care
Schedule an Appointment

We are happy to work with your busy schedule! With nine physicians and four offices, we are confident we can find a time, day and location that is convenient for you. Call 941-748-1818 and let us help you on your way to seeing more clearly!


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