Excessive lacrimation – epiphora
Healthy eyes have to be moist, so a special tear gland located above the outer third of the upper eyelid produces tears. There are other glands in the eyelid that are also involved in production of all the components of tears. With each blink, the eyelids disperse tears over the eye surface, and excess tears are drained into the nose through the lacrimal canal. That is why our nose runs when we cry.
Constant or excessive lacrimation, in which the eyes water all the time or tears run down the cheek, is called epiphora in medicine.
Cases when the problem of excessive lacrimation, caused by nasolacrimal duct obstruction, cannot be solved, are extremely scarce. Depending on the blockage nature, the chance of success in this surgery procedure ranges from 80 to 95%. In most patients, excessive lacrimation after surgery stops completely, and in some it appears only in certain situations, for example, in a cold wind.
What causes excessive lacrimation?
There are many possible causes of excessive tear production. We will name just a few of them.
Evaporation with dry eyes or lacrimal reflex seems to be the most common reason. This has to do with a defect in the meibomian glands activity; usually they produce an oily substance that constitutes a part of our tears. This substance prevents the tear fluid from evaporation between blinks. If these glands do not function properly, the fluid evaporates too quickly, leaving the sensitive eye cornea vulnerable. To compensate this, the lacrimal gland reflexively produces excessive volume of tears, leading to overflow in the tear drainage system, as in crying.
• The lower eyelid falls off the eye and turns outward (ectropion).
• Decreased tear draining (narrowing). The drainage, sometimes called the tear duct, may also be completely blocked or not working. Its blockage may lead to painful swelling in the eyelids inner corner (dacryocystitis).
Babies born with a blocked tear duct have watery eyes and an infection in the tears that causes discharge accumulation between the eyelids. This problem usually disappears on its own within a few months.
• Pump failure leading to reduced action of eyelids and tear drainage system. This often happens due to weak or drooping eyelids that are unable to channel tears to the drainage tube in the inner corner of the eye.
Treatment depends on the cause of the excessive lacrimation. Sometimes additional assessment is required using a special form of X-ray examination of the tear drainage path (dacryocystogram) or a mapping test (radionuclide dacryoscintigraphy).
DCR - Dacryocystorhinostomy
Surgical procedure for removing a blockage of the tear duct is called (Dacryocystorhinostomy - DCR) and is usually performed under general anesthesia. In some cases, when a patient is eligible for general anesthesia, this procedure can be performed under local anesthesia with intravenous sedation by an anesthesiologist.
During the surgical procedure, a new duct is created between the lacrimal sac and the inside of the nose by removal of a thin bone between them. Dr. Avisar may temporarily insert small silicone tubes to keep the tear duct open during the healing period, for about a month. DCR is usually performed through a small skin incision on the nose side (external DCR). This surgical procedure can now be performed with access through the nose, preventing skin incision, and the results with this technique are more or less the same as with external DCR.
DCR eliminates the risk of inflammation in the lacrimal sac (dacryocystitis) that can develop when tears are stagnant in the lacrimal sac due to a blockage in the nasolacrimal duct. It is a painful condition that requires antibiotics and sometimes even injections and drainage of the lacrimal sac. After DCR, tears do not stagnate and, therefore, the risk of the lacrimal sac infection is eliminated.
Jones Tube is an artificial lacrimal canal made of Pyrex glass that stays in place at all times. This procedure is usually performed under general anesthesia, although it can be performed under local anesthesia with intravenous anesthesia by an anesthesiologist for patients unfit for general anesthesia.
Jones tube can be used during unsuccessful DCR surgery and for patients with a nasolacrimal canal blockage caused by scarring, recurrent infections or aging.
Probing and flushing the tear duct
Probing and flushing the tear duct usually improves the condition of a baby born with tear drainage problem that does not improve spontaneously by the age 8 months up to one year. If there is no improvement after this procedure, additional surgical procedure may be required.
This surgery can help in cases of impaired tear drainage. It is usually carried out with local anesthesia.
Lower eyelid correction surgery
Intended for patients with the lower eyelid eversion (ectropion).
These are eye drops for prevention of dryness in the eyes, that leads to increased tear production. A wide range of artificial tears is available in pharmacies. Some patients prefer one or another type of artificial tears for their own reasons, so it is recommended to try different types. If you have to use these drops more than four times a day, it is recommended to choose a type of drops that does not contain preservatives. Dr. Avisar will be able to advise you which drops to try, and she often performs experimental treatments with lubricants when identifying the underlying cause of dry eyes.
Reduction of tear duct openings
If artificial tears do not relieve dry eye discomfort enough, tear ducts reduction can help keep more moisture in the eye; in this case, the eye will be healthier, and will not hurt so much.The reduction of the tear duct openings can be carried out for a certain period with the help of silicone plugs or, in a more permanent way, by surgery. In any case, the procedure is performed under local anesthesia. In particularly difficult cases, additional treatments may be required to correct dry eye problems.
What to expect after the surgical procedure for watery eyes treatment
• This surgery/procedure is usually carried out with a day hospitalization. Many patients want to stay overnight, but if they feel well, they can return home on the same day.
• While the silicone tubes are not yet removed, the eyes may water; if you need to wipe your eyes, do it towards the nose so as not to pull out these tubes.
• After surgery, it is recommended to rest for two to three days, but if necessary, you can travel and return to normal and relaxed activities on the next day.
• Do not blow your nose in the first week after surgery.
• At the first postoperative visit, the placement of the tubes is checked and the stitches are removed if an external DCR was performed.
• At the second post-operative visit, the site of the drain is checked in the clinic and the silicone tubes are removed.