However, in addition to tear duct blockage, there are many other causes of watering eye, including reflex tearing, eyelid laxity, blepharitis, dry eyes, facial palsy, eye drops and drugs. The oculoplastic surgeon assesses the cause of the watering eye. If the watering eye is due to a blocked tear duct the treatment is surgical.
A tear drainage operation is called a dacryocystorhinostomy (DCR). DCR is either done from the inside of the nose, known as an endonasal or endoscopic endonasal DCR, or via a small curvilinear skin incision hidden in the tear trough, which is known as an external DCR. A very small number of patients have damage to the small ducts (canaliculi) and they will need, initially a DCR and subsequently a Jones’ lacrimal bypass glass tube.
Assessment of a patient with a watering eye is made by the oculoplastic surgeon at the consultation. First, a thorough history is taken, as the watering eyes may be related to blepharitis or dry eyes, allergies, eye drops, drugs and trauma. In particular, a history of nasal problems and sinusitis may be an important factor in contributing to the lacrimal duct narrowing and subsequent blockage, with resultant watering. The peri-orbital region, eyelids and surface of the eye are then thoroughly examined and additional clinical tests are done which can involve simple orange coloured dye called fluorescein, syringing and probing, and nasal endoscopic examination. A very small number of patients with a partial blockage of their nasolacrimal duct (functional nasolacrimal duct obstruction) may require a special radiological examination called lacrimal scintigraphy, which helps to determine the level of the functional block. A dacryocystogram, or CT scan, may be required to look at the outline of the lacrimal sac and to see the orbital bones, the nasolacrimal duct and the sinuses.
Lacrimal tests done at Clinica London
Syringing and probing:
This test is done under topical local anaesthesia (eye drops) with the patient sitting comfortably in the examination chair. It helps confirm the site of the narrowing or obstruction causing the watering eye. First, a small drop of topical anaesthetic is put onto the eyes, then the tiny openings, called the puncta, are dilated gently and a lacrimal cannula is passed carefully along the canaliculus towards the lacrimal sac. This is not felt by the patient. A small amount of saline is used to irrigate the duct and determine the position and extent of the blockage. A lot of inflammation can be obtained from this simple test.
This test is also done under local topical anaesthesia (nasal spray or soaked cotton buds) with the patient sitting comfortably in the examination chair. The fine torch, called an endoscope, is used to look just inside the nostril. From this position the oculoplastic surgeon can see right up into the nose and diagnose any disease that may be present, and assess the suitability of the nasal space for DCR surgery and whether any other small procedures need to be done within the nose to assist the surgery.
The treatment of watering eyes is entirely dependent on its cause. If the cause of the watering eye is blepharitis or dry eye, with ocular irritation and reflex tearing, this is treated non-surgically with eyelid hygiene, lubricant eye drops (artificial tears) and occasionally antibiotic creams or tablets.
If the cause is dacryocystitis, with a painful swelling of the lacrimal sac due to a blocked tear duct, it will treated initially with oral antibiotics for five days, then a DCR will be done. DCR consists of making a permanent surgical opening from the lacrimal sac into the nose, through which the tears will then drain freely, resulting in relief of the watering eye symptoms.
If the cause of the watering eye is a blocked tear duct (nasolacrimal duct) the choice is then a DCR done through the nose, or an external approach DCR (through the skin), or a combination of the external approach with endoscopic endonasal monitoring.
At the end of the DCR surgery, soft silicone tubes are placed between the corner of the eye and the inside of the nose, which are then removed approximately 4-6 weeks after surgery.
The success rates for both endoscopic endonasal DCR and external DCR are in the range of 85% to 95%. However, if the cause has been more complicated than simple obstruction of the nasolacrimal duct, this figure can be lower.
At Clinica London Jane Olver specialises in endoscopic endonasal lacrimal DCR surgery. She also has pioneered Light Tears where she uses an external approach curvilinear skin incision hidden in the tear trough to access the lacrimal sac, together with the endoscope inside the nose for both illumination and to assist navigation during the surgery. This combined approach, of combined external and endoscopic DCR (CoExEn), provides results between 95% and 100%.
Jane Olver specialises in carrying out surgery on patients who have failed previous DCR surgery, who have had complicated trauma, previous sinus surgery and other diseases. She uses a special external and endoscopic approach, with fine intranasal instruments to delicately recreate an opening between the sac and the nose, to enable tear drainage.
If the cause of the watering is a blockage of the fine tear ducts (canaliculi) then the DCR is done first, with subsequent insertion of a small glass bypass tube, called the Jones’ tube, under local anaesthetic a few weeks later. This is a permanent bypass tube which has very good results, but with the inconvenience of the tube.