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What is epiphora?

Epiphora is the medical term for a watering eye from a tear duct obstruction. The tear ducts are comprised of tiny puncta. Puncta catch the tears at the corner of the eye going down small channels called canaliculi into the lacrimal sac. The lacrimal sac is in the little alcove on the side of the nose inside the orbit below the medial corner of the eyelid.
The lacrimal sac then drains a bony tube called the nasolacrimal duct. The nasolacrimal duct is mucosa lying in the bony tube and opens into the lower part of the sidewall of the nose.
A watering eye can from increased tear production or hypersecretion from a dry or irritated eye, or the impaired outflow of tears.
Very occasionally both exist and that is why an oculoplastic surgeon is required to take the history, examine the patient’s eyelids, tear film and tear duct system to identify how much of the tearing is reflex or hypersecretion and how much of it is outflow obstruction.
If it is hypersecretion, this higher tear production can be treated medically by treating the inflammation of the lid margins such as blepharitis or by treating the dry eye. If the tear production is normal, but the tears just cannot drain out, then the treatment of choice is a DCR (Dacryocystorhinostomy).
There are three main choices of approach for DCR:
1. Endoscopic endonasal DCR.
2. External DCR.
3. Combined external and endoscopic endonasal DCR, also known as COEXEN-DCR or LighTears.
Recent technical advantages in the last 20 years have completely revolutionised watering eye surgery and enabled us to offer minimally invasive highly successful surgery. In the “olden days” when I first became a Consultant at Hillingdon Hospital and the Western Eye Hospital, many patients were going untreated for their watering eyes, dacryocystitis, because their doctors had advised them that it was a “terrible operation with blood loss”. Well, that has all changed now. There is very rarely much blood loss with DCR, and it is extremely well tolerated. It’s performed under local anaesthetic and has high success rates.
There is always a downtime for any surgery for DCR surgery. This is about ten days during which the nose is a bit blocked with a nasal pack, the tubes are still in, and there may be some bruising. Tubes usually are removed round about three weeks after surgery. In my practice, I offer a fully comprehensive range of tear duct surgeries for watering eyes, including all three main types of DCR. I also do Jones tubes, which I will tell you more about in another blog post.

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