Epiphora – Watery Eyes

THE WATERY EYES

Tears are produced by special glands around the eyes. They help wash, clean and lubricate the front of the eyeball, and therefore they are important in maintaining a healthy eye.

Tears normally drain away through two tiny openings called punctum that are located in inner aspect of both the upper and lower lids. Each of these is connected to the tear sac by very fine tubes called canaliculus. The tear sac is located in the inner corner of the eye next to the nose. A bony canal called the nasolacrimal duct drains the tears from this sac into the nasal cavity.

WHAT CAUSES A WATERING EYE?

There are several very different causes of a watering eye. Different tests will allow the correct cause to be found and the appropriate treatment to be given. These are a few reasons for a watery eye:

• Inflammation of the eyelid edges (called blepharitis) can result in excessive amounts of tears being produced.
• An abnormal eyelid position (also called entropion and ectropion) can result in the punctum no longer being in the best position to collect the tears.
• A narrowing of the drain hole (also called punctual stenosis) can prevent tears draining away.
• A blockage of the tear drainage duct will prevent the tears from being drained away. It is possible to check for this by syringing salt water through the tube. If the tube is working normally then the salty solution can be tasted in the back of the throat. This is a simple procedure and can be done in the outpatient department.

HOW CAN WATERING EYE BE TREATED?

Treatment depends upon the cause of the watering.

• Inflammation of the eyelids can be treated by lid hygiene and topical medicine.
• Abnormal lid positions such as entropion and ectropion can be treated with surgery to correct the lid position (Entropion / Ectropion repair).
• Punctual stenosis can be treated by a small operation to enlarge the tear drainage hole. This can often be performed in the minor operations room following an injection of local anesthetic.
• Treatment of a blocked tear duct depends on the patient’s age and the exact type and location of the obstruction. In very young children (under the age of one) the blockage may resolve naturally but a few children may require a small procedure (probing of the naso-lacrimal duct) under general anesthesia to relieve the blockage. In adults, a blocked tear duct is usually overcome by an operation called dacryocystorhinostomy (also called DCR). This is usually done under a general anesthetic as a day-case procedure.

DCR operations can be done via the nasal passageway (Endonasal DCR) so there is no visible scar. Sometimes it is necessary to do the DCR via a skin small skin incision. Your consultant will discuss what is the most suitable procedure for you.