What is watery Eye?
Tears are constantly produced by our eyes to keep the eyes moist and clean. These tears should drain into the throat via a system of tubes connecting the eye and the nose (see Pic). Any alteration in this process can lead to tears flowing out of the eyes/ onto the cheek, and this is called epiphora/ watery eyes.
What causes Watery Eye?
Eyes can water in 2 scenarios
- Increased production of tears
- Obstruction in the drainage of tears
Increased production of tears usually occurs as a reflex mechanism wherein the eye is attempting to wash out an irritant, such as a foreign body/ infection/ allergen.
It also sometimes paradoxically occurs in patients who have dry eyes. In this condition, the eyes reflexively produce tears to compensate for the dryness, which is excessive, and hence results in watering.
An obstruction in the outflow of tears may occur at any point in the path of normal tear clearance.
Punctual stenosis/ Punctual occlusion
Absence of the punctum / punctal agenesis
Canalicluar stenosis/ canaliculitis
Nasolacrimal duct Obstruction (most common)
Nasal pathology such as deviated nasal septum/ inflammation/ polyp
What are the symptoms of Watery Eye?
Watery eyes can cause:
- Problem seeing things clearly/ blurred vision
- Repeated eye infections
- Red, irritated, swollen, or painful eyes
- Skin around the eyes can become dry and sore
- Sticky discharge
What are the treatment options?
The treatment modality will depend on the cause of watering, and hence it is imperative to first establish the exact cause of watering. To this end, Dr Sneha will conduct a thorough examination which may include tests like Fluorescein Dye disappearance test, Schirmer's test, Syringing. Rarely other investigations such as Meibography, Tear Osmolarity, Inflammadry, Lipiscan, Dacryoscintillgraphy, Dacryocystogram or a CT scan may be requested.
Treating the cause may involve
- Antibiotic drops or tablets to treat an infection
- Removing a foreign body if present
- Patching the eye in case of abrasion
- Correcting the position of the eyelid (such as Entropion/ Ectropion/ Lagophthalmos)
Overcoming the obstruction
- Syringing and probing
- DCR surgery
- Conjunctivocystorhinostomy with Jones tubes
- Canalicular trephenation
- Botulinum toxin to the lacrimal gland
On this page we will discuss treatment of the most common cause of watering: Blocked nasolacrimal duct.
Non surgical treatment
Occasionally when the blockage is temporary, as seen in acute infection (acute dacryocystitis) or inflammation (nasal congestion), treating with antibiotics or anti-inflammatories may relieve the blockage.
However, more commonly, the blockage is permanent, and a surgical intervention is required
The most common surgery performed is called a Dacryocystorhinostomy or DCR. In this surgery, Dr Sneha creates an alternate pathway for the tears to flow into the nose, bypassing the blockage in the tear drainage duct. This can be done by 2 approaches
External DCR- when the tear duct is approached from the skin
Endonasal DCR- when the tear duct is approached from the nose
Other procedures which may be done in certain specific conditions include:
- Nasolacrimal Intubation
- Syringing and Probing (link)
- Balloon Dacryoplasty
What does DCR surgery entail?
DCR (Dacryocystorhinostomy) is usually done as a day case procedure with discharge from hospital on the same day.
Prior to the procedure, certain assessments and tests are carried out to ensure fitness for surgery. Dr Sneha will discuss with you the type of anesthesia and accordingly guide you regarding the need for fasting on the day of surgery. The procedure takes about an hour. The procedure itself entails creating a bypass pathway from the corner of the eye to the nose, for the tears to flow. Sometimes, Dr Sneha places a temporary silicone tube in the pathway to allow for better healing.
In External DCR, a 1cmm cut is made on the skin beyond the inner corner of the eye. At the end of surgery this may be closed with a few stiches/ glue. This wound usually heals quite well, usually leaving only a faint to imperceptible scar by 3 months.
In Endonasal DCR, the entire procedure is carried out through the nostril of the same side. It is usually done under general anesthesia. Patients feel they recover more quickly when the procedure is done endoscopically due to the absence of an external wound.
After the surgery, expect some discomfort and nasal stuffiness in the initial few hours and days, which is controlled by pain relieving medication.
What is the recovery time?
Dr Sneha recommends 2-3 days of complete rest. By 1 week, stitches, if present, are removed and routine activities may be resumed. Strenuous exercises, lifting heavy weights etc are best avoided for upto 6 – 8 weeks. If a tube is placed, it is removed in a month's time in the clinic.
What are the potential complications?
DCR is a very successful, commonly performed surgery.
- Some experience nasal stuffiness and bleed
- Skin scar may be visible in External approach
- Rarely, the new drainage path may also get blocked