Watering eyes (Epiphora)
More information
Excessive tearing or the problem of tears overflowing down the cheek is called watering eye or “Epiphora”. This 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 form of X-ray examination of the tear drainage pathway or a test utilizing a tracer is required to assist in the assessment.
Epiphora is commonly caused by
- abnormalities in the lacrimal drainage system such a scarring due to injury, recurrent infection, the ageing process and surgery is required to improve the condition
- Sometimes 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!
- A blockage at the lower end of the nasolacrimal duct is the most common cause of a tear drainage outflow problem.
What happens before eyelid surgery?
You will visit the clinic a few days or weeks before the date of your surgery, to have a preoperative consultation with your surgeon. He or she will ask you questions about your current and past health, and will need to know about any allergies you may have, medications you are taking (including over the counter products e.g. aspirin, indomethacin or vitamin supplements), previous surgery, the previous use of fillers or botox injections and whether you smoke.
You may also be required to have a physical examination of your heart and lungs by the anaesthetist to make sure it is safe for you to have an anaesthetic (if this is necessary your procedure will be carried out at Manchester Eye Clinic, The Alexandra Hospital Cheadle or the BUPA Hospital Whalley Range.) You may need to have some routine laboratory tests, such as urinalysis (tests of your urine), chest x-rays, or complete blood cell counts. These should reveal potential problems that might complicate the surgery if not detected and treated early. We may not need to carry out any tests if you are in good health and younger than 55.
All questions should be answered completely and honestly so that your surgery can be planned as carefully as possible. If you are unsure of the names of any medications, bring them with you and you will be told whether it will be necessary to stop any medications at this preoperative clinic visit. For example, if you are taking aspirin-containing medicines or anticoagulants, they may need to be temporarily withdrawn or reduced in dose for two weeks before the procedure. If you can, try to stop smoking at least six to eight weeks prior to surgery.
Your eyes will be carefully examined and your vision in each eye measured. The pressure within each eye may also be measured, and the back of the eye (the retina) examined, as well as the eyelids and the nose. The positioning of the eyelashes will be noted. The surgeon will also examine the general state of your skin, e.g. for the presence of acne or scars, and will take a photograph of your face before surgery so that the results of surgery can be compared with the original appearance.
What should I expect at the clinic?
The procedure will be explained to you and you will then be asked to sign a consent form saying that you understand the procedure and that you have been told about any possible complications. Very rare complications will be described, as well as any more common ones, so that you can keep things in perspective. If you have any questions or worries, make sure they are answered, before you sign the consent form. You are quite free to go away and consider the options before committing yourself to any surgery. You can then write to us or email us requesting further information if required.
What happens at Surgery?
Watering eye surgery can be performed under local anaesthesia. “Twilight anaesthesia” which is local anaesthesia with intravenous sedation given by an anaesthetist, is also available.
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| A silicone stent |
If general anaesthesia is required the surgery is performed at a local private hospital. During surgery a nasal mucosal flap is raised to expose the bone of the lacrimal fossa floor, which is then removed using ronguers and a diamond burr. Once the lacrimal sac is exposed it is opened in a vertical fashion to form anterior and posterior flaps which are laid open against the lateral wall of the nose. A silicone stent is placed via the lacrimal canaliculi to maintain the new passage while healing takes place.
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 – an external DCR, or through the nose with the use of an endoscope (a surgical telescope) – an endoscopic DCR. The success rate of both approaches in our hands 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
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| A Lester Jones Tube |
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| A patient with a Lester Jones tube |
The CDCR operation is performed for patients who have a complete blockage of the tear duct, 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 avoiding the need for an external incision and a scar.
Side effects
Complications in the hands of a trained and experienced oculoplastic surgeon are very rare and all precautions are taken to minimise any risks. An oculoplastic surgeon undertakes watering eye surgery routinely and is trained to prevent and to manage any problems. The main risks of this type of surgery are bleeding, and infection, but such problems are very rare.
After DCR or CDCR surgery
- You may have some minor intermittent nose bleeding which will take 3-4 days to settle. Avoid any activity which can provoke a nose bleed e.g. lifting heavy weights or straining
- You may have difficulty wearing your glasses for a short period after surgery (external DCR only)
- You may experience nasal stuffiness but this will gradually improve. Avoid blowing your nose or rubbing your eye
- If you have undergone an endoscopic DCR you will be instructed to perform regular nasal douching using “Sterimar” which you can purchase without prescription at the chemist. You will also be prescribed nasal sprays to use for a week after surgery.
- Antibiotic ointment should be applied to the site as directed (external DCR only)
- The sutures are usually dissolvable but can be removed after 3-4 weeks (external DCR only)
- The silicone stent may come out as a loop in the inner corner of the eye. If this happens it can be taped it to the side of the nose– this is not an emergency so call us in normal working hours but DO NOT CUT IT OR PULL IT
Why Face & Eye?
- Our specialized ophthalmic/oculoplastic surgeons’ particular area of expertise is in operating on the delicate structures around the eyes
- Our experts can also provide a comprehensive assessment of any underlying medical ophthalmic problems during your discussion of the available treatment options.
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