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The Watery Eye

Why do eyes water?

In order for the eye to remain healthy, it must remain moist. The lacrimal gland is a specialised gland located under the outer one-third of the upper eyelid that makes tears. Each time you blink, the eyelid spreads the tears over the surface of the eye and pumps excess tears into a "duct" that drains the tears into your nose. That is why your nose runs when you cry. Excessive watering may occur due to excess tear production, a deficiency in the quality of tears or due to obstruction in the draining channels. The latter is more common. Less commonly, the blinking or ‘pumping’ action of the lids may be faulty. Typically the symptom of watering tends to be worse outdoors and often gets aggravated by cold and windy weather.

What can happen then?

If the tear duct gets blocked and results in swelling of the tear sac by the side of the nasal bridge, the stagnant tear may get infected giving rise to a painful abscess forming condition called ‘dacryocystitis’.  If the tear ducts are blocked and the tearing is responsible for severe symptoms, surgery can be performed to create an alternative tear passage (bypass). This operation is called "dacryocystorhinostomy" (DCR). This operation is usually performed under general anaesthesia with you being put to sleep. The DCR operation may be done via the nose using special equipment or through the skin by the side of the nose. The latter is more traditional (and considered the gold standard) but can give rise to a scar which is usually faint and small. Approach via the nose is often suitable for only certain patients and your doctor will be able to advise you on that. Your doctor may place small silicone tubes temporarily to keep the new tear duct open while healing occurs and removed after 3-5 months. Surgical bypass of the obstruction by creating a new tear duct is necessary to improve excessive tearing and infections that can result from such a blockage. You will have skin stitches which are usually removed a week later.

Are there any risks or side effects?

 Postoperative nose bleed can sometimes occur, within the first 48-72 hours (nasal spotting is not uncommon for the first 24-48 hours).

·    Small risk of infection of the orbit or sinuses.

·    Tenderness on the side of the nose that may last for a few months.

·    Transient bruising around the eye.

·    You may have a conspicuous scar.

·    Risk of failure (the alternative tear duct closes up due to scarring).

What are the Benefits?

·    Relief of symptoms, i.e. watering.

·    Reduces the risk of recurrent infection.

Precautions Postoperatively

·    Avoid very hot drinks for the first 48 hours. (you need to cool them down prior to consumption to reduce the risk of nose bleeds).

·    Avoid blowing your nose for the first week after the operation.

·    In case of a persistent nose bleed please attend casualty immediately or follow the advice given preoperatively.

Special situations

Occasionally, the "tear duct" obstruction will be beyond repair. When this happens, it is necessary to surgically implant an artificial "tear duct" behind the inner corner of the eyelids to drain the tears into the nose. The artificial "tear duct" is made of Pyrex glass and is called a "Lester Jones tube."

Can this condition affect children?

Children are frequently born with an obstruction within the "tear duct." When this occurs, tearing results. The stagnant tears within the "tear duct" often become infected causing pus (heavy matter) to collect between the eyelids. Such obstructions usually resolve on its own within the first few months of life. If not, the oculoplastic surgeon can eliminate this problem with surgical techniques which may vary from simple ‘no cutting or stitching’ procedure to temporarily placing silicon tubes or even DCR surgery as carried out in the adults.