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Deborah arrived with a broad smile for her post operative appointment at Clinica London, “This could put the tissue companies out of business!” she said.
Ten days earlier consultant ophthalmic and oculoplastic surgeon, Jane Olver, had performed an intricate lacrimal drainage repair operation which involved replacing her blocked tear ducts with tiny pyrex tubes.
“Having exhausted all other possible surgical solutions for Deborah’s extremely watering eyes, a ‘conjunctivo-dacryocystorhinostomy’ (CDCR) and the implantation of glass Lester Jones tubes was seen as the last resort”, explained Jane.
“This operation is not for everybody who suffers from watering eyes – other treatments and procedures are tried first. Typically this surgery would be carried out on patients who have suffered a trauma to the area or a chronic inflammation”, said Jane who is also currently treating a woman who damaged her eyes in a horse riding accident and a 14-year-old who had suffered from viral conjunctivitis, who also have Jones tubes.
Tears are necessary to keep the eyes moist and comfortable. They are constantly produced by the lacrimal glands (above and outside each eye) and also by the small cells found in the membrane that covers the eyeball (the conjunctiva). The blinking process spreads these tears over the front of the eye.
In a healthy eye, tears drain away through tiny channels known as canaliculi and then into a tear “sac” before flowing down a tube – the nasolacrimal duct - and into the nose. Other than emotional crying, an “overflow” would only occur if extra tears are produced to wash away any irritant – like fumes, an eyelash or a piece of grit - also if there is a scratch on the eye or an infection such as conjunctivitis.
It is the very young – babies of up to a year – and the elderly who most usually suffer from watering eyes.
“The largest tear drainage channel - the nasolacrimal duct - which goes from the lacrimal sac to the nose sits in a bony area. In the elderly, where it might become ‘furred up’, or in the case of a chronic inflammation, it becomes too narrow to function properly resulting in watering eyes.
Ironically, some elderly people might not notice the problem as they are also suffering from age-related dry eye, so the excess moisture can balance things out for them.
In young adults, the more usual cause of watering eyes is either an infection or the side effects of medication such as chemotherapy treatments. For Deborah she had probably had a conjunctivitis which caused her to canaliculi to scar.
Jane carried out Deborah’s surgery in two stages. The first part was to prepare for the insertion of the Jones tubes by removing a part of the little fleshy swelling at the corner of the eyes in order to make a small alcove in which to sit the head of the glass tube.
The surgery to insert the Jones tube- between the inner corner of the eye and the nose -was carried out two weeks later.
“Not everyone with watering eyes needs a Jones tube, this is a niche, highly specialised area and patients are referred to me from throughout the country and overseas”, said Jane. “I perform this procedure with the use of an endoscope up the nose – the camera allows me to place the Jones tube in the exact right position. It also avoids the need for a skin incision and so does not leave a scar.”
“To begin a small suture is required to hold each tube in place- in Deborah’s case 12 mm tubes were the correct size. During the first 6 weeks they should bed in on their own.”
After examining Deborah’s eyes to see how well the Jones tubes were ‘settling in’, Jane announced that the early indications were ‘encouraging’.
A “sniff test” is a necessary part of the post operative routine. Patients must sniff in and out while holding the other nostril making sure that air can go up and down the Jones tube. Ten days after her operation Deborah was sniffing well.
“There is no inflammation and it all looks very encouraging at this stage.
“Of course its early days, but it is certainly looking good, the tubes have bedded in well”, announced Jane.
“They were a bit messy for a few days after the operation”, said Deborah “and there was some watering especially on the right eye, but that has now cleared up. This is a different progression from the previous operations which were dry at first then progressively the excessive watering returned.”
Do her eyes feel uncomfortable or painful? “I am aware of them at times, especially when I am tired and maybe first thing in the morning. There is a sensation of having something in the corner of my eye, but that seems to be lessening with each day.”
London, 30th September 2011