Watering eyes (Epiphora)
And the use of Dacryocystorhinostomy (DCR) and Lester Jones tubes
The condition referred to as ‘watering eye’, or the excessive production of tears to the point where they can overflow down the cheek is known as “epiphora”. It can have many different causes, and the treatment will depend on the cause e.g. if the lower eyelid is sitting away from the eye (an ectropion) the eyelid will need to be repositioned. Occasionally a special x-ray or a tracing test may be required to identify the root problem. Usually though the condition can be put down to an abnormality in the tear drainage process caused by scarring due to injury, recurrent infection or just as the result of the aging process.
Occasionally a dry eye can lead to excessive tears when glands in the eyelids do not function properly. This causes the tear film to evaporate quickly, leaving the sensitive cornea exposed. The tear glands then produce an excessive volume of tears. This often leads to confusion with patients failing to understand why they have been prescribed artificial tears to improve their symptoms!
Corrective surgery can be performed under local anesthesia, “twilight anaesthesia” which is local anaesthesia with intravenous sedation given by an anaesthetist, or under general anaesthesia. .
Dacryocystorhinostomy (DCR)
A DCR is performed where there is an obstruction in the tear drainage system by making a small incision on the side of the nose, or through the nose with the use of an endoscope (a surgical telescope). The success rate of both approaches when performed by Face & Eye surgeons is better than 95%. During the surgery a fine silicone tube (a stent) is put in place to maintain an opening in the tear drainage system. This is removed later. If this surgery is not totally successful the symptoms may be resolved by the use of a Lester Jones tube.
Conjunctivo-dacryocystorhinostomy (CDCR) and Lester Jones tube
The CDCR operation is performed for patients who have a complete blockage of the tear passages in the eyelids, often following trauma. The operation is very similar to a DCR but instead of a removable silicone stent, a tiny pyrex tube is placed between the inner corner of the eye and the nose which is almost invisible. Unlike a stent, this remains in place indefinitely. This surgery is most often performed endoscopically.
Surgery for an ectropion can be performed on a day case basis where you arrive at the clinic and leave shortly after the surgery. A DCR or CDCR and Lester Jones tube procedure can be performed under local anaesthesia with sedation but most patients prefer a general anaesthetic for this. For this reason this procedure is usually performed in a local private hospital usually with an overnight stay. Someone must be available to take you home (and stay with you until the next day if you have had any sedation).
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