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Watery Eyes (Adult)

Tears are constantly produced by tear gland situated on the outer corner of upper lids. With blink, the tears are distributed on the surface of eyes and are drained via the tear drainage system into the nose.

The tear drainage system of the eye starts with two small opening along the edges of the inner part of the upper and lower eyelids. It then continues into a sac along the side of the nose and finally opens up further down towards the back of the nose. Blockage can occur anywhere along this system. In some cases, there may not be an actual blockage of the tear duct, but the eye waters because the normal pumping action of the duct is not very effective (functional block).

What can be done to help this?

Some supportive decongestive measures like nasal spray or treatment of eyelid inflammation can improve watery eyes in about 20% of patients. Otherwise surgery is the only option.

Is an operation my only choice?

If you do not have an operation the symptoms of watery eye tend to persist, but there is no danger to your eye or vision.

If I decided to have an operation will I need to stay in hospital?

You will need to come into hospital for the operation and stay overnight.

Is an anaesthetic required?

A general anaesthetic is usually required. In exceptional cases (e.g. when the risk of a general anaesthetic is deemed too high), the operation can be done under local anaesthetic.

What happens during the operation or procedure?

There are two main approaches to lacrimal surgery. These are external (external DCR) or via the nose (endonasal DCR).

The technique which is performed via the nose may be surgical or with a laser. There may be slight variations in the procedure and success rates depending on the position of the tear duct blockage.

Both external and endonasal DCR surgery involves opening up the tear sac and adjacent bone so that there is a direct connection between the sac and the inside of the nose (upper end) bypassing the blockage in the tear drainage system.

External DCR involves making a cut in the skin along the side of the nose, but the procedure through the nose does not require this. Silicone tubes are usually inserted through the surgical opening to stop it from closing. One end of the loop will be visible in the corner of the eye whilst the other end will be inside the nose. This tubing is usually removed 2-3 months after surgery.

*Removal of this tubing is a simple procedure and is done in the outpatient clinic.

What are the risks and benefits of these operations/procedures?

External DCR

The success rates for this surgery vary from 50 to 96% depending on where the blockage is. The success rate improves when the obstruction is closer to the nose and becomes less when it is situated nearer the eyelid or is a functional block. With functional blocks there is a 25% chance of making the watering worse.

Possible post-operative complications include:

• Infection (8%)
• Wound scarring or numbness (20%)
• Bleeding

These complications are rarely serious but do require management. Infection and bleeding can usually be treated effectively. Skin numbness also tends to improve with time. Very rarely can one develop more serious problems like double vision or loss of vision.

Endonasal DCR

Success rates for this approach range from 54% to 93% depending on the level of obstruction as for external DCR rates and also whether the blockage is functional. Possible complications from surgery include bleeding and air being trapped under the skin (orbital emphysema). Again these are not very serious and can settle spontaneously or be treated. Double vision and loss of vision can very rarely occur.