Lacrimal/Watery Eye Surgery
What causes watery eyes?
Watery eyes, otherwise known as epiphora can be caused by an over production of tears, difficulty getting the tears to the ‘plug hole’ in the inner corner of the eyelid and the tears not passing through the drainage system into the nose.
What symptoms does it cause?
Patients often complain of tears spilling down their cheeks, giving the impression to others they are crying. The tears spilling over the eyelid can lead to dermatitis, crusting and stickiness. The eyes feel damp and the vision can become blurred due to the high tear film. Rarely patients may experience an acute infection whereby they develop a lump in the inner corner of their eyelid. If a patient has sticky tears and/or watery tears this can often give a clue as to where the problem is located.
What treatment is available?
Treatment depends on the location and cause of the watering.
Overproduction of tears
Patients may have a condition which causes them to overproduce tears through conditions such as blepharitis and dry eye. Treatment often includes a lubrication regime as well as blepharits treatment.
Eyelid malposition
Just like the gutters on the roof of your house help to move water to the downpipe, the eyelids function to direct tears into the drainage apparatus which is located in the inner corner. Should there be an ectropion (outward position) or looseness this will cause tears not to pass to corner and spill over. Surgery involves correcting the abnormal eyelid position (see ectropion surgery).
Obstruction of drainage
Many cases of epiphora stem from an abnormality in the drainage apparatus located in the corner of the eyelid and nose – either a blockage or an impairment in function. An operation called a dacryocystorhinostomy (DCR) is often performed whereby the internal nasolacrimal duct is bypassed to allow the tears to drain more directly into the nose. The surgery can be performed either externally or endoscopically and needs to be performed in a hospital.
External DCR
This approach is through a small cut in the skin on the sidewall of the nose. The scar is barely noticeable once it heals up. The nose is accessed by removing bone and the lacrimal sac is sutured to anterior and posterior nasal flaps. Silicon tubes are placed to limit scarring and removed at 1 month.
Endoscopic DCR
This approach is through the nose using a telescope (endoscope) to view the inside of the nose. Bone is then removed to access the lacrimal sac from the inside. Similar to an external DCR silicon tubes are placed.
Which surgery is right for me?
Our Ophthalmic Plastic Surgeon Dr Christopher Stewart will review your examination findings and discuss the advantages and disadvantages of each approach. External and endoscopic DCRs are day surgery, each take 60-90 minutes and there is minimal post-operative pain.
Previous DCR Surgery, Complex cases
Patients may have undergone a DCR previously which has failed. Surgery to correct this may involve a repeat DCR procedure or placement of a Lester Jones Tube.
What is the recovery?
Recovery from surgery is generally straight forward. Patients often experience some mild swelling which resolves over the course of a week or so. Should you have an external DCR, sutures will be removed at 1 week. Both endoscooic and external DCRs require removal of stents at 4 weeks. This is done in the rooms and is well tolerated.
What are the risks?
Significant risks of surgery involve scarring in the lacrimal sac limiting the success of the surgery. Nose bleeds are relatively uncommon.
