Lacrimal /watering eyes

Overview dacryocystorhinostomy ("DCR")

For patients with blocked tear duct, the usual cause of a watering eye

The tears normally drain from the corner of the eye close to the nose, via tiny puncta into the very fine lacrimal drainage channels (canaliculi). The tears go into the lacrimal sac, then down the nasolacrimal duct which lies in a bony canal, then opens into your nose. You are not aware of the tears draining into your nose and these go down into the throat.

The most common cause of watering eyes is a blocked nasolacrimal duct. Surgery to overcome this blockage is called "dacryocystorhinostomy" or DCR.

In order to confirm the site of the obstruction causing the watering, lacrimal syringing and gentle probing is done.

The aim of this operation is to relieve a watery, sticky eye caused by blockage of the tear duct (nasolacrimal duct) situated between the tear sac (lacrimal sac) at the corner of the eye and the tear outflow passage into the back of the nose.

DCR consists of creating a direct connection between the tear sac into the nose, bypassing the blockage and allowing tears to drain normally again. Usually some soft silicone tubes are placed, which are removed about two months after surgery.

There are two methods of doing this:

• Externally (from the outside, via a short skin incision)
• Internally (from inside the nose: endonasal endoscopic)

The Watering Eye

• Why do eyes water?

  In order for the eyes to be healthy they need to be kept moist with tears. However, too many tears, or failure of drainage of the tears, will result in a watering eye.

• Where do tears come from and how do they drain?

  Tears are produced in the lacrimal gland, which is a special gland located under the outer one third of the upper eyelid. Each time you blink the eyelid spreads the thin layer of tears over the surface of the eye, and then there are some muscles in the corner of the eye which help drain, or pump, the excess tears down into the lacrimal sac and duct towards the back of your nose.

• What is the cause of a watering eye?

  Watering eye can occur when there is excess tear production or due to obstruction in the drainage channels. Excess tear production can be caused by simple common conditions, such as inflammation of the eyelid margins (blepharitis) or, paradoxically, having a dry eye so that there is excessive or hypersecretion of tears. An obstruction of the drainage channels is a common cause of watering eyes. Rarely, the blinking, or pumping action of the eyelids, may fail and cause a watering eye.

• What are the symptoms of a watering eye?

  Typically the symptoms of a watering eye, due to an obstruction of the drainage channel, is watering worse outdoors, aggravated by cold and windy weather.

• What can happen with an obstructed drainage channel?

  If the drainage channel, or tear duct, or nasolacrimal duct as it is called medically, gets blocked there can be a swelling of the tear sac above it, at the corner of the eye on the side of the nose. This can cause, in addition to the watering, a small swelling at the corner of the eye, regurgitation of mucous to the eye if the swelling is pressed, or even a painful abscess condition called dacryocystitis. Sometimes the blockage of the drainage channels affects the very fine ducts close to the eyelids called the canaliculae.

• What is the treatment of a watering eye?

  If the watering eye is caused by an obstruction of the drainage channels, then surgery can be done to overcome the obstruction. Surgery is performed to create a new tear duct by an operation called dacryocystorhinostomy, or DCR. This operation is most commonly done under general anaesthesia, with patients being put to sleep, but can be done under local anaesthesia.

• Tell me more about a DCR operation

  A DCR operation can be done via the nose using a special endoscope, light source and fine instruments. This is called endoscopic endonasal dacryocystorhinostomy. Alternatively, it can be done via a small skin incision on the side of the nose, which is called external approach dacryocystorhinostomy. The latter is more traditional but can rarely give rise to a small scar on the skin and therefore many patients prefer the endonasal endoscopic approach. Approach via the nose is often very suitable and your ophthalmologist will advise you on that.

  At DCR surgery small silicone tubes are placed temporarily along the duct while healing occurs. These tubes are removed a few weeks later, after which the watering and/or stickiness should be eliminated.

• Can watering eyes affect children?

  Children are frequently born with an obstruction within the tear duct called congenital nasolacrimal duct obstruction, resulting in tearing. Fortunately, the tear duct usually opens spontaneously as the child's face develops and over 90% of children born with this obstruction will have opened their duct completely and resolved the problem of watering by the age of one year.

• What is the treatment of a watering eye?

  If the watering eye is caused by an obstruction of the drainage channels, then surgery can be done to overcome the obstruction. Surgery is performed to create a new tear duct by an operation called dacryocystorhinostomy, or DCR. This operation is most commonly done under general anaesthesia, with patients being put to sleep, but can be done under local anaesthesia.

  Occasionally the stagnant tears in the tear sac become infected, causing a small lump to appear at the inner corner of the eye and some pus or heavy matter to collect between the eyelids, which might require earlier surgical intervention. If a child still has a watering eye after the age of one, the ophthalmologist can carry out a simple surgical manoeuvre under a short general anaesthetic to probe and open the obstructed tear duct, possibly pass tubes or, if there is a significant block found, do a DCR, as in adults.

• Are there any specific situations I need to be aware of?

  Occasionally the tear duct obstruction will be beyond repair, such as following severe trauma, or if the fine canaliculae (the little drainage tubes in the eyelids) are severely obstructed. When this happens, it is necessary to surgically implant an artificial tear duct behind the inner corner of the eyelid to drain the tears into the nose. The artificial tear duct is made of pyrex glass and is called a Jones' tube.