Excessive watering of the eye is a common reason for referral to an oculoplastic and lacrimal surgeon. Often the treatment is non-surgical or involves correction of an eyelid malposition. A proportion of these patients have an obstruction or increased resistance in the lacrimal drainage system and they need tear duct surgery. This needs assessing before the surgery.
Dacryocystorhinostomy (DCR) surgery is tear-duct relieving surgery. It involves fashioning a connection between the lacrimal sac and the lateral wall of the nose. The surgeon makes an opening through the bone, which separates them. The new drainage opening above the blocked tear-duct relieves the watering eye.
DCR may be done through a skin incision over the lacrimal sac. It is also possible via the nose (endoscopic DCR), or a combination of both.
The surgeon places temporary silicone tubes, which are removed after about three weeks. Rarely a permanent glass by-pass tube called a Jones Tube is necessary. Only if there is a lot of damage to the small tear-ducts called the canaliculi or there is poor eyelid function.
“Oculoplastic and lacrimal Surgeons are Specialists in Watering and Dry Eyes”
This is tear drainage surgery done from within the nose. Endoscopic endonasal DCR requires the surgeon to be proficient with a nasal endoscope. It is sometimes necessary to correct abnormalities of the nasal septum or turbinate bones to gain access. The ophthalmologist must get either the necessary competencies in nasal surgery or get the help of an ENT surgeon.
I specialize in this approach as it makes the best of both worlds. I get the super magnification and accuracy within the nose, and also a big wide field of view through a small tear trough incision. With combined external and endoscopic DCR, the surgeons see all. This gets the best results with getting rid of watering eyes. Also, it does not leave a noticeable skin scar.