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Treatment for watering eyes on London’s Harley Street
Watery eyes, a condition that is medically referred to as Epiphora, is a common eye problem which can affect people of any age. It occurs when the tear-drainage system fails to properly drain the tears from the eyes.
Tears are produced naturally to help lubricate the eyes, avoid them becoming too dry, and rid them of anything unwanted, such as dirt and dust. However, in some people, the eyes may water excessively, resulting in too many tears being produced.
What causes watering eyes?
Having watery eyes is normal in certain environments, such as when it is very cold or windy, or when the air is smoky or dusty. Other frequent causes of watering eyes include grit or eyelashes entering the eye, or allergies, colds and sinus problems.
However, if the problem is persistent then it could be caused by a particular condition, including;
- Blocked tear ducts
- Dacryocystitis – swelling of the lacrimal sac due to blocked tear duct
- Entropion – inward-rolling eyelids
- Ectropion – eyelids drooping away from the eye
- Blepharitis, which is known as dry eye
- Dry eye syndrome, which often leads to the eyes producing too many tears
- Conjunctivitis, a common eye infection resulting in inflammation
While the condition can affect anybody, it appears most frequently in older patients and children.
What are the symptoms?
The obvious symptom is watering eyes and excessive tearing, which can lead to other problems, including blurred vision, irritation of the eyelids, discomfort, soreness and “sticky” eyes. Many patients also feel embarrassed when in social settings or during work, as other people often mistake their eye condition for crying.
When should I seek medical help?
Whilst experiencing watering eyes from time to time is not uncommon, it is important to speak to your GP if it is so bad that it is interfering with your normal life. If you encounter loss of vision, have swelling or lumps around the eye area, or have painful, sore eyes, then you should see a doctor. Likewise, the eyelids drooping or turning inwards may be a cause for medical attention.
Although many babies under the age of one have watery eyes due to small tear ducts, if you notice that your baby has red, sore or extremely watering eyes, you should take them to a doctor.
How do you treat watery eyes?
For many people, treatment will not be necessary, especially if the watering eyes are not excessive and are not causing problems. For persistent, severe symptoms, patients should first speak to their GP and an optician, who should be able to identify the root of the problem. If the cause is not immediately obvious, the doctor may need to refer you to a specialist ophthalmologist, who will carry out a full examination of the tear ducts.
If treatment for watery eyes is necessary, then the type of treatment will be entirely dependent on its cause.
Blepharitis or dry eye
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, known as artificial tears, and occasionally antibiotic creams or tablets.
Patients will be given advice on how to keep the eye clean and hygienic and may also be advised to avoid participating in any activity that flares up symptoms.
If the cause of watering eyes is an allergy, a doctor will likely prescribe some medication that helps to alleviate symptoms.
If the cause is dacryocystitis, with painful swelling of the lacrimal sac due to a blocked tear duct, it will be treated initially with oral antibiotics for five days, after which a Dacryocystorhinostomy (DCR) will be carried out.
DCR surgery 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.
Blocked tear duct
If the cause of the watering eye is a blocked tear duct (nasolacrimal duct) the choice is then to have 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 is more complicated than a simple obstruction of the nasolacrimal duct, this figure can indeed be lower.
Endoscopic endonasal lacrimal DCR surgery
Clinica London’s 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 carried out 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.
DCR surgeries take between 1-1.5 hours and are performed under general anaesthetic or local anaesthetic with sedation.
How do I prepare for watery eyes treatment?
During an initial consultation, the surgeon will talk through your medical history and examine the eyes. Other measures, such as weight and height, may also be taken. Pregnant or overweight people may be asked to postpone surgery until it is safer to undergo.
Smokers should cease smoking for six weeks prior to the surgery in order to reduce risk of complications and to ensure a better healing process. Likewise, blood-thinning medication, such as Aspirin or Ibuprofen, should not be taken for two weeks before.
On the day of the surgery, patients must not eat or drink for up to six hours before. Before going to the operating theatre, the surgeon and anaesthetist will see you and mark you up.
What happens during the post-surgery recovery period?
Once out of surgery, patients will need to stay in the hospital for some time as the anaesthetic wears off, after which a friend or family member should pick you up. It is not safe to drive yourself home after surgery. Older patients or children may need to stay at the hospital overnight.
Some bleeding is normal after surgery, but you should go to A&E if this is extremely heavy. Patients should avoid blowing their nose for the first 10 days as this can cause heavier bleeding.
The eyes may continue to water for several weeks after the surgery due to swelling and inflammation, but this will calm down once the tubes have been removed 4-6 weeks later.
If external DCR surgery is performed, the patient’s eye and side of their nose will be bandaged up, which can be removed at home the following day. A nurse will provide instructions on how to properly clean and wash the area. Rubbing the eyes should be avoided, patting the area dry instead.
If in pain, an ice pack can be applied to help lessen swelling and bruising and over-the-counter pain medication can be taken.
Patients should also apply prescription eye drops four times per day, regardless of which treatment method is used. A nasal spray may also be prescribed and should be applied five days after surgery for the next three weeks. The spray helps to loosen any crusts or scabs that form inside the nose, which is particularly common in Endo DCR patients.
Follow-up appointments are necessary to remove the stitches and, after 4-6 weeks, to remove the tubes in the nose. A progress review with the surgeon should be arranged after six months to assess the results.
Will I need any time off work?
Patients are advised to rest following watery eye surgery, and most people will need about a week off from work. Strenuous activities, such as heavy lifting and exercising, should be refrained from for the first week.
Are there any risks involved?
Though unlikely, any surgical procedure has its risks, but at Clinica, you are in safe hands. All possible complications will be discussed with you during a consultation. Patients will also be given detail information in written form, which summarises the risks and ensures the patient consents to the procedure.
1 in 50 people will experience bleeding for up to ten days after watery eye surgery.
In rare cases, other risks can include infections, blockages which may mean the patient needs another operation, and the displacement of the tube that was put in the nose.
If patients have undergone external DCR, a small visible scar on the side of the nose may be present for a few months afterwards. This usually disappears on its own, but sometimes, massaging the area may be necessary to help it disappear.
How much does watery eye treatment cost?
Prices will depend upon the type of procedure carried out and the individual patient. For watering eye treatment using the DCR method at Clinica London, prices range from £4200-£7000. This includes surgeon and anaesthetist fees, hospital fees and the removal of the tubes. Consultation fees are not included.
Please book a consultation for a written quote with a full breakdown of treatment costs.
Read more about the Watery Eyes condition.