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Tear duct surgery

Treatment for watery eyes, including punctoplasty, eyelid surgery and DCR (dacryocystorhinostomy)

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Why do eyes water?

Tears are very important for keeping the front of your eye hydrated and protected, but if the balance between tear production and tear drainage is disrupted then the eyes can water (known as epiphora).  This can cause discomfort and frustration, and can give the appearance of crying in unwanted situations.

Many factors influence the production of tears, including blepharitis (inflammation of the edges of the eyelids), allergies, and dry eye syndrome.  These can sometimes coexist with tear drainage problems, compounding the issue.

The position of the eyelids is important, as an out-turning lower lid (ectropion)​ can cause tears to spill over onto the cheek.  An in-turning lower lid (entropion) can irritate the eye, causing increased production of tears.  Additionally, sometimes very loose lids can contribute to watering as they can affect the tear drainage pump.

The tear drainage system (outlined below) can become blocked, either partially or completely.  Common sites for narrowing or blockage are the entrance to the tear drainage system (punctum) and the outflow (nasolacrimal duct).

Watery eye tear drainage system.jpg

Tears are produced mostly in the lacrimal gland (A), are collected at the punctum (B) and drain into the nose through the nasolacrimal duct (C)

Treatment of watery eyes

Often, several factors can combine to cause the eyes to water.  It is important to ensure that any blepharitis, dry eye syndrome and allergic eye disease are treated appropriately.

If the eyelid is out of position, this can be treated effectively with surgery under local anaesthetic (see ectropion and entropion). 

If there is narrowing of the entrance of the tear duct (punctal stenosis), this can be addressed by enlarging the punctum with a short procedure under local anaesthetic (punctoplasty).

If the lower part of the tear drainage system (nasolacrimal duct) is narrowed or blocked, then this can be addressed with surgery to bypass the blockage (dacryocystorhinostomy, more commonly known as DCR surgery). 

DCR Surgery

Dacryocystorhinostomy, or DCR, is an operation to bypass the lower portion of the tear drainage system (nasolacrimal duct).  It is typically carried out under general anaesthetic, and you would go home later the same day.  

It is important to let your surgeon know if you take any blood-thinning medications, such as Aspirin, as these are often paused temporarily before surgery to reduce the risk of bleeding.  

During surgery, a silicone stent is usually placed in the tear duct to help to keep it open during the healing process.  This is removed in the clinic, typically around 6 weeks after your operation.

After your operation, it is best to avoid hot food and drinks for at least 24 hours to reduce the likelihood of bleeding from the nose.  It is important to avoid blowing your nose for 10-14 days after surgery for the same reason (gently wiping your nose is fine).  You should avoid strenuous activity for at least a week.  

It is normal to have a small amount of bleeding from the nose in the first few days after surgery.  About 1 in 50 patients will have a significant nose bleed after surgery.  Usually this will resolve on its own, and can be helped by the application of an ice pack to the bridge of the nose.  However, if the bleeding continues for more than 30 minutes, or if you feel unwell, you should attend your nearest accident and emergency department.

DCR surgery successfully improves watering in 90-95% of patients with blockage of the nasolacrimal duct.  It is also very effective at treating sticky discharge associated with a collection of mucus in the tear drainage system ('mucocele'), and recurrent infections of the tear drainage system ('dacryocystitis').

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