Watery Eye and DCR Surgery in London
Watery eye (epiphora) and the surgery Dacryocystorhinostomy (DCR)
What is a watery eye (epiphora)?
A watery eye is an excess of tears on the eye, causing the tears to blur the vision or overflow onto the cheek. It may also lead to a runny nose and excessive tearing can be intermittent or continuous depending on the cause. The medical term for this condition is epiphora. DCR surgery is used to treat a blocked tear duct.
What causes it?
The most common cause of dry eye is a dysfunction in the lacrimal gland, which produces tears in response to the eye being dry. Artificial tears are often recommended as a first-line treatment for this problem.
Other common causes include:
Blepharitis of the eyelids
The eyelids contain multiple oil glands called meibomian glands. These secrete oils that form an important part of your tears. If these oils do not come out properly, a condition called dry eye can develop, causing watering.
Allergic conjunctivitis
To treat an allergic reaction, the body produces a watery discharge and itchy eyes. The allergic reaction results in increased tear production as the eye remains irritated. Allergy sufferers such as those who have hay fever can say that their eyes tend to water when their symptoms are bad and less so when the allergy symptoms are under control. When this occurs, there may be vision changes due to the teary eyes.
An eye infection
Infective conjunctivitis (known as pink eye) or more urgently, a contact lens-related injection can cause irritation to the eye surface. Extra tears are produced in an attempt to remove whatever is causing the irritation. It is important to see your eye doctor if you wear contact lenses and have an eye infection.
The eyelids being too lax with entropion or ectropion
The eyelids perform a vital function. The lids form part of the tear pump, which moves excess tears from the eye. As you blink, the pump pushes the tears into the tear ducts. If your eyelids become too loose, they no longer push the tears effectively. This tends to happen in older adults. With increased laxity in the lower lids, the eyes can turn outwards (ectropion) or inward (entropion). This can result in further drainage and drainage problems due to watery eyes.
A blocked tear duct
Normal tear drainage occurs when tears come from the tear gland, creating a tear filler that then drains into the tear sac and into the lacrimal duct. When this process is disrupted–as when a blockage prevents tears from draining effectively–watering can occur.
An injury to the eye like a scratch or corneal abrasion
A corneal abrasion can lead to watering of the eye. Reflex tearing that occurs as a result of the injury usually settles as the eye heals, but it may require medical attention to make sure there are no other injuries. Your doctor may provide you with an ointment.
How do you stop a watery eye?
When it comes to eye-watering, the underlying cause needs to be addressed in order to stop the symptoms. Dryness and blepharitis are common culprits of this issue and can often be treated with warm compresses applied directly onto eyelids as well as dry eye drops. Baby shampoo diluted in water may also help improve tear film quality and relieve dry eyes, but should not be used if it causes irritation or discomfort.
If allergies or hay fever are causing your eyes to water, anti-allergy drops or over-the-counter antihistamines might do the trick for you. For any kind of infection that is present around your eyes, a doctor will likely prescribe eye drops or an ointment for treatment.
Viral conjunctivitis caused by a cold usually clears up on its own without medical intervention; however, some people experience persistent irritation due to this condition which can require a medication from a healthcare provider if needed.
If you have drooping eyelids, you may need surgery to tighten the lower lid. This is known as an entropion or ectropion repair. If the opening to your tear duct is too small, this can be widened with a simple procedure called a punctoplasty or 3 snips which are done under local anesthesia.
For a tear duct blockage, dacryocystorhinostomy surgery is required. This creates a bypass to the blockage allowing the tears to drain.
What does it mean if one eye keeps watering?
One eye-watering may indicate a narrowed or blocked tear duct. An assessment in the clinic can determine whether this is the case. Mr. Ahmad Aziz, in his London clinic, is able to assess your eyes and drainage ducts to see if you have a blockage or narrowing. In children, the most common cause of one eye watering is a blockage to the tear duct which has not yet fully developed. With time and massage, this can settle by age 2 years.
What does it mean when a baby eye keeps watering?
Infants can develop blocked tear ducts, which may resolve on their own or with massage, By the age of 2 years if the tearing is persistent then this has to be probed under a general anesthetic to assess the tear drainage and see if there is a membrane that can be unblocked without the need for bypass surgery, Less commonly, a child may need to undergo bypass surgery or a dacryocystorhinostomy (DCR) if symptoms persist.
Which eye drop is best for watery eyes?
Eye drops are recommended depending on the cause, In infants if Epiphany is due to allergies, allomide is recommended, Older children and adults can use batanol eye drops. Both of these drops are part of the antihistamine family to calm and settle any allergic component that may cause irrigation.
Multiple dry eye drops there are a range of options available. Sodium hyaluronate is one of the first-line drops that is given to help treat dryness and promote the booking of the outer surface of the eye.
Other drops include carmelose, hypromellose and carbomer gel with different strengths and some of them work better in some patients. Less commonly, steroid eye drops are used if there is evidence of inflammation. In severe dry eyes cyclosporine is a drug in drop form that can be applied once a day to help treat symptoms.
What home remedy can I use for watery eye?
watery eye – Home remedies include regularly hot flannels to the eyelids in an attempt to improve the quality of the tear. Some people do not feel comfortable using hot flannels and a thermal eye mask can be used instead. Other options with less evidence from clinical trials include increasing omega-3 intake and using diluted t-tree oil on the eyelid margin.
Can eye drops help watery eye?
Drops can help with watering eyes if the cause is infection, dryness or allergy. Drops tend to only improve comfort if the problem is caused by laxity of the eyelids. Interestingly, tears can sometimes help in a blockage of a tear duct even when the main problem is not with the tear duct itself but with other factors such as allergy or dryness.
Does glaucoma cause watery eye?
Glaucoma can cause irrigation. This is because some glaucoma medications contain a preservative that can irritate the eyes, leading to tearing. The eye should be evaluated to make sure there is no other cause. If it seems that it may be due to glaucoma medication, the treatment is to change the medication to formulations without a preservative.
Irrigation can rarely be a sign of acute angle glaucoma, and therefore if irrigation is associated with redness of the eyes, pain, halos in vision, blurred vision, this requires urgent attention.
What is a Dacryocystorhinostomy (DCR) operation?
DCR surgery is a common procedure used to treat blocked tear ducts, also known as nasolacrimal duct obstruction. The operation creates a new passage for the tears to drain from the tear sac and nose, allowing them to flow normally.
It is usually performed under general anaesthetic with you asleep during the procedure which typically takes 1 hour. In some cases where having a general anaesthetic may be less safe, an external DCR can be done under local anaesthesia if it’s not possible for you to go into surgery. This will be discussed with you prior to your operation so that together we can decide on what would best suit your needs and preferences.
There are two methods of DCR surgery. An external approach and an internal approach. Most people prefer an intranasal approach because it avoids a scar on the side of the nose. An external approach is used in people who are unable to receive a general anesthetic and in cases where passage through the nose is not possible. This will be discussed with you during your consultation.
Is DCR surgery painful?
The surgical procedure can feel sore for a day or two and this can be treated with simple pain relievers. Most people do not experience severe pain. The laparoscopic approach may have less pain due to the absence of a scar.
How long is the recovery from the surgery?
Following a nasal procedure, most patients can expect to see the bruising and swelling noticeably settle within two weeks. This will result in a more natural look which gives you the confidence to go out publicly. In most cases, any subtle swelling that may be noticed should resolve over two months.
Additionally, there may also be some spotting or bleeding from the nasal cavity following treatment; however people are usually able to return to their normal activities after one week of rest and recovery time.
To encourage success of your DCR:
- Try to sit up and sleep on 1 or 2 extra pillows at night
- Avoid blowing or picking your nose for one week after having had you surgery.
- Use paracetamol painkillers for any discomfort but avoid taking aspirin and ibuprofen which can encourage bleeding.
- Try to avoid any strenuous exercise or activity for two weeks after you procedure
- Also avoid exercise especially swimming for two weeks after surgery.
- Try to avoid travelling by plane for seven days after your operation.
How is tear duct surgery performed?
The essence of lacrimal surgery it bypasses the lacrimal canal and creates a new passage for tears to pass from the lacrimal point on the margin of the eyelid to the lacrimal sac and into the nasal cavity at the nasal level on the nasal mucosa called the middle meatus. The DCR procedure effectively creates a new lacrimal drainage system. It can be done with endoscopic dacryocystostomy or externally with a small scar.
Is tear duct surgery necessary?
Tears from the eyes usually drain into the nose through a tear duct, which starts from the inner corner of the eye and ends inside the nose. When the tear duct becomes blocked, tears are unable to drain as normal, which can cause the eyes to water and increases the risk of infection in the tear duct, known as dacryocystitis. Treatment of blocked tear ducts may involve the use of medications or surgery to remove the obstruction.
To assess if a tear duct is blocked, an oculoplastic surgeon may perform a dye test. During this 5-minute test, a dye is injected into the tear duct, and the surgeon will observe if the dye drains properly. If the tear duct is blocked, the dye will not drain and will instead reflux back, causing the eye to water. If the tear duct is not blocked, the dye will drain down the throat and be tasted. In some cases, the surgeon may also attempt to flush the tear duct to check for an obstruction.
Is the surgery safe?
The surgery is generally considered safe. The risk factors to the operation include
- Anaesthetic risks are assessed at your preoperative assessment.
- The procedure may fail in approximately 5% of patients. The risk is higher if it is a repeat procedure or you have inflammatory medical conditions that can cause excessive scarring. In these cases, mitomycin C may also be applied at the time of the operation.
- Persistent watery eye even if there is anatomic latency, because the cause of the problem is usually multi-factorial.
- A small scar on the side of the nose can be a result of an external procedure.
- Some bleeding from the nose
- A risk of infection which is small
What is endonasal dacryocystorhinostomy?
Endoscopic DCR
Under general anesthesia, a nasal endoscope is inserted up the nose in order to access the tear sac and bypass the blockage site. The tear sac is then opened and allowed to drain through a new passage. To keep the passage open as the nose heals, a flexible, colourless tube is inserted and then removed after around six weeks, once the nose has healed. This procedure has a success rate of approximately 90%, and leaves no scar on the side of the nose, making it a popular choice for younger and increasingly elderly patients. The advantage of an endoscopic DCR is that it is usually entirely scar-free.
External DCR
External dacryocystorhinostomy (DCR) is the most common surgical procedure for treating blocked tear ducts. It involves making a small incision on the side of the nose in order to access the tear sac, which is located behind the medial canthal tendon in the lacrimal fossa. During the surgery, a small amount of bone from the anterior lacrimal crest is removed, and the nasolacrimal sac is opened, forming an anterior and posterior flap. A new passage is created for the tears to drain, and a flexible silicone tube is inserted to keep the passage open while the nose heals. The tubes are then removed after 6 weeks, and the incision is stitched up and the stitches removed 2 weeks later. Endonasal DCR is also gaining popularity, due to its advantages, and has a success rate of over 90%. Your surgeon will discuss both options with you and help you decide which is most suitable for you.
How do you remove a DCR tube?
The tube is usually kept in for 6 weeks, and is typically removed in a clinic setting in a straightforward and painless procedure. The tube is removed from the inner aspect of the eyelid near the lower punctum. It is retained for 6 weeks to help ensure that the new passage remains open as it heals and to improve the chances of successful results. Functional success is determined by the improvement of the tear duct system once the surgery has fully healed.
What is the success rate for DCR surgery?
Approximately 90% of people who undergo DCR surgery experience resolution or improvement of their watery eye and are satisfied with the results. Many people notice a significant difference in their symptoms after the procedure, and the results typically last a lifetime. However, in 10% of cases, the surgery may not be successful, and they may need to undergo another procedure.
Any bruising associated with the procedure usually resolves within 2 weeks, giving you the confidence to go out in public. Endonasal DCR does not leave any scar, whereas an external DCR leaves a small 1 cm scar on the side of the nose, near the medial canthus. This scar usually fades with time, but you should still protect it from sun exposure, just as you do with the rest of your skin.