With each blink, tears spread from the tear gland across our eye, to be pumped by the tear pump through a tiny tear drain into the nose. Tears are important for eye health; too few tears cause a dry eye whilst too many cause a watery eye.
Watery eye occurs when the tear drain becomes blocked, or if the tear pump fails. In the early stages, the eye intermittently fills with tears, called fullness. As the problem worsens, tears pool around the eye and flow onto the face, this is called Epiphora. Aside from watering, patients may complain of sticky discharge, pain, a lump in the corner of the eye, tenderness, dryness, grittiness and blurred vision. Patients often carry a tissue to wipe the eye, and develop an eye rubbing habit, unaware that this causes more damage to the tear pump and makes the problem worse.
Tear drain blockage
The tear drain can become blocked at different levels. During your consultation, a probe may be passed into the tear drain to locate the blockage, and then flushed with anaesthetic. This tear drain washout is minimally uncomfortable and may clear the blockage.
Tear pump failure
The tear pump fails most commonly due to nerve damage, eye rubbing or with age. Without a pump, tears will not flow into the nose. The severity of pump failure can be assessed after DCR surgery.
To treat watery eye, we follow 3 logical steps:
- Correct tear drain blockage
- Correct eyelid problems
- Correct tear pump failure
- In most cases, the first step is Keyhole Watery Eye Surgery called DCR
Keyhole Watery eye surgery
The technical name for this surgery is Endoscopic Dacryocystorhinostomy or DCR for short (pronounced “dee.cee.are”). This keyhole operation is performed entirely inside the nose using a telescope and specialised microsurgical instruments to open the tear drain and create a clear path for tears to enter the nose. Sometimes, entry into the nose is blocked by a deviated nasal septum, which is straightened at the time of surgery. If a tear drain blockage occurs in zone 1 of the tear drain, small silicone tubes are placed at the end of surgery, to be removed several weeks later in the office. Because it is key hole surgery, there is no cuts to the skin and no visible signs of surgery.
Surgery is performed at almost any age, from children to adults. If both eyes water, then we advise surgery on both sides to save a second anaesthetic and recovery period. DCR surgery is a day procedure taking less than 90 minutes and recovery is relatively quick. You may shower and wash your hair from day 1, and return to work within a week.
After DCR Surgery
The only discomfort most people report is an ache at the base of the nose. There may be an initial trickle of blood from the nose which settles over 24 hours. Small packs placed inside the nose at surgery will be removed at the first post-operative visit, following which, nasal rinsing begins to keep the nose clean which is essential to success of the surgery. You can blow your nose once packs are out.
The eye will likely be watery for a few days or weeks and improve once the stent is removed. Patients notice an improvement anywhere from day 1 to month 3, depending on the cause of watering. If more than one cause exists, such as a blockage and a tear pump problem, then a follow-up procedure will be required.
Appointments are arranged for week 1, 4 and 8. Whilst this surgery is technically invisible to the outside world and creates no skin scarring, some patients experience swelling at the base of the nose with tenderness whilst wearing glasses.