Reconstructive Services
Tear Duct/Lacrimal Surgery
Patients with watery eyes and tearing are commonly referred to an oculoplastic surgeon. Tearing symptoms can range from mild intermittent watering to constant profuse tearing.
There are many causes of watery eyes, but in general, they can be broken down into three broad groups:
First, “reactive” tearing is typically occurs when an environmental irritant (dust, wind, temperature), or ocular surface irritant (dry eye, blepharitis, foreign body, allergic reaction) causes the eye to reflexively water. Patients will usually notice that their eyes water intermittently, and will be better or worse depending on environmental conditions. Treatment usually involves the use of lubricating and/ or anti-inflammatory eye drops.
Second, tearing can occur when the tears do not easily transverse across the ocular surface to the opening of the tear drain (called the punctum). This is often due to a problem with lid support or function, or when tissue obstructs the opening of the tear drain. Patients will generally complain of intermittent or near constant watering. Ectropion, a loose eyelid, eyelid paralysis, excess eye surface tissue (conjunctivochalasis), and a tight tear duct opening (punctual stenosis) can all cause this type or tearing. Treatment involves surgical correction of the eyelid malposition or ocular surface irregularity.
Third, tearing can be cause by a tear duct blockage (lacrimal duct obstruction). Patients often complain of constant profuse tearing. There are many causes of a blocked tear duct, but the most common is called “primary acquired lacrimal stenosis”, which essentially means the cause is not known. The blockage can occur at any point along the entire length of the tear duct, but most commonly occurs within the deep part near the nose. The treatment for a tear duct obstruction is typically surgical and can range from simply “stenting” the system to more involved surgery. The most commonly performed surgery for a blocked tear duct is dacryocystorhinostomy (DCR). DCR surgery is basically a tear duct bypass procedure. DCR reroutes the tear duct around the blockage and creates a new pathway for tears to flow. A temporary stent is frequently placed during DCR surgery and is removed after complete healing. If the fine, delicate beginning of the tear duct (called the canaliculus) is blocked, a small device called a Jones tube can be placed to permanently bypass the blockage. DCR and/ or Jones tube surgery takes around 1 hour and is performed as an outpatient. The recovery time is about 1-3 weeks.
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