Excessive production or under-drainage of tears leads to tears flowing down the cheeks. This may cause blurring of vision, interfere with daily visual tasks, sore skin in the eyelids and cheeks from recurrent wiping of tears and may lead to social embarrassment. If you have severe symptoms, this may require the attention of an eyelid and lacrimal specialist.
Tears are produced by the tear glands and drained away through fine passages at the inner corner of the eyelids into the nose. Tears are essential in keeping the surface of the eye clear, moist and healthy. Blinking spreads the tears evenly across the cornea which acts as the ‘windscreen’ of the eye to allow us to achieve optimum vision.
The most common cause of excessive tear production (reflex tearing) is caused by Dry Eye Disease (DED). In this case poor quality tears do not sufficiently wet the cornea and nerve fibres on the surface of the eye send signals to the tear gland to produce more and more tears. This would benefit from dry eye treatment.
Common causes of under-drainage may result from eyelid problems or the narrowing or blockage of tear drainage channels.
A consultation and examination is essential to establish the main cause of the watering eye. This will often involve tear duct syringing to test the patency of the tear drainage system. Sometimes when tear duct surgery is a possible option a nasal endoscopy will also be carried out to check there are no significant problems and that there is adequate space in the nose for the surgery.
If the watering is mainly due to dry eye then this has to be treated (refer to Dry Eyes page). If poor drainage is the main cause of the watering then the cause of tear drainage needs to be determined. In some patients, eyelid surgery may be recommended. In others
minor surgery to enlarge the punctum (opening)of the tear duct drainage system (puncto-canaliculoplasty), may be enough to control the watering. In more severe cases a tear duct bypass operation called DCR (DacryoCystoRhinostomy) may be required to bring relief.
Endonasal DCR procedure
In most patients the surgery can be performed endonasal (from the inside of the nose). This avoids an external scar. The surgeon bypasses the narrowing or blockage in the tear duct by joining the lining of the tear sac to the lining of the nose. This newly made passageway is initially kept open by small polythene tubes. These are removed in the outpatient clinic in the ensuing weeks or months after surgery, which are removed later when the rhinostomy (the join between the tear sac and the lining of the nose) has healed sufficiently, depending on the severity of the blockage. In some patients this procedure involves nasal procedures to improve surgical access and is sometimes done jointly with an ENT surgeon.
External DCR procedure
The DCR operation is performed through a 1-1.5 cm incision on the side of the nose where the scar is often invisible. The surgeon bypasses the narrowing or blockage in the tear duct by joining the lining of the tear sac to the lining of the nose. The newly made passageway is kept open by the small plastic tubes which are removed later when the rhinostomy (the join between the tear sac and the lining of the nose) has healed sufficiently, depending on the severity of the blockage.
Complex Lacrimal Procedures
Sometimes patients with complex tear duct obstructions may require a permanent glass bypass tube.
The operation is usually performed under general anaesthesia with the patient asleep. Occasionally it can also be performed under local anaesthesia with the side of the nose ‘frozen’ by an injection and intravenous sedation.
Note: All treatment is preceded by a detailed consultation and examination to establish the correct diagnosis.