What is Eye Watering?
Tearing or epiphora is a relatively common problem and one of the most common symptoms reported by patients attending an ophthalmologist’s office. Epiphora can be a very uncomfortable problem for the patient, as it requires them to constantly wipe away tears to prevent them from running down their cheeks, in addition to causing blurred vision. Some patients find this embarrassing and even avoid social gatherings for this reason.
What are the causes of tearing?
There are many causes of tearing, so the key to successful treatment is a thorough initial examination by an ophthalmologist specializing in the tear duct. A simple way to understand it is to classify epiphora into those caused by abnormalities in the tear drainage system and those caused by excess tear production. The tear system can be altered anywhere, from the beginning of the canaliculi to the nasolacrimal duct. Occasionally, the system is permeable to examination but does not drain tears properly; this is called functional epiphora , since it is the function, not the structure, of the tear duct that is altered. Newborns may occasionally present with a low obstruction of the nasolacrimal duct. This is usually due to an immaturity of the system, which in most cases resolves spontaneously before the age of one. In adults, the most common involvement of the tear system occurs at the level of the nasolacrimal duct . For unknown reasons, the duct narrows with age and may even close completely. This occurs more frequently in women over 50 years of age. Stenosis of the lacrimal duct, in addition to causing tearing, makes the tear sac more prone to infection. This is called dacryocystitis and is characterized by pain, redness, and sometimes an abscess in the area of the tear sac.
FAQs de Lagrimeo de ojos
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The normal drainage pathway for tears originates at the inner corner of the palpebral fissure, near the nose. From there, two small ducts called the lacrimal canaliculi branch off. These originate in the upper and lower eyelids and drain into the lacrimal sac , a structure closely linked to the nasal passages and paranasal sinuses. The lacrimal sac drains directly into the nose through the nasolacrimal duct . Under normal conditions, the volume of tears is imperceptible in the nose as they are reabsorbed with the aid of the continuous flow of air. When we cry, however, the increase in tear volume is perceived as nasal mucus.
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When the patient with tearing presents with a normal tear duct, we must look for other causes. In this case, it is important to carefully examine the ocular surface, since any problem at this level causes irritation and, reflexively, an increase in tear production . One of the most common problems of the ocular surface that can present as epiphora is dry eye. Dry eye is a very common condition in which there is a deficit in tear production, either in quantity or quality. Although it may sound contradictory, dry eye can cause tearing. When the ocular surface is not adequately protected by the tear film, irritation occurs, causing great discomfort to the patient and, at the same time, causing the main tear gland to momentarily overreact to protect the ocular surface. This reflex increase in tear production does not adequately protect the eye, since the main tear gland primarily produces the aqueous volume of the tear film, but lacks the mucinous components that cause the tear to form a film and remain on the ocular surface. Therefore, patients often describe these bursts of reflex tearing as “watery eyes” or as epiphora running down the cheek. Treatment for these types of tearing is aimed at resolving or improving the process causing the irritation of the ocular surface.
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Obstruction of the nasolacrimal duct can only be treated surgically and is called dacryocystorhinostomy (DCR). This involves creating a new tear duct from the lacrimal sac to the nose, bypassing the obstructed nasolacrimal duct. This is an outpatient procedure performed under local anesthesia with sedation in the vast majority of cases. The traditional approach to DCR involves an approximately 1 cm incision in the skin of the inner corner. This incision provides access to the lacrimal sac and the nose, creating the new duct. External DCR is the most effective technique, although it has the disadvantage of a small scar and a somewhat slower recovery time than endoscopic techniques. In many cases, the scar is imperceptible. The endoscopic approach through the nose achieves very similar results to external surgery, with the advantage of being a shorter procedure, without scarring, and with a faster recovery time. Whenever possible due to the patient’s nasal anatomy, we recommend the endoscopic approach. In both approaches, a small silicone tube is placed through the newly created tear duct to keep it open during the healing process. The normal healing process would tend to close the new duct, so the tube acts as a stent, keeping it open. This tube is removed between 6 and 10 weeks after surgery and can be performed in the office because it is painless.
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Undergoing DCR surgery, especially if it’s endoscopic, won’t significantly impact your daily activities. We recommend rest for the first 1-2 days after surgery. After that, if the patient feels well, they can return to work. The postoperative period isn’t painful . Typically, if the surgery is performed on a Thursday or Friday, the patient can return to work the following Monday. We do recommend avoiding vigorous physical exertion for a week. Furthermore, the patient should avoid blowing their nose for the first week. The first postoperative visit takes place one week after the procedure. If an external approach was used, the stitches will be removed during this visit. The second visit will be to remove the catheter.
