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WATERING EYE

What is Watering Eye ?

Watering eye is known as epiphora. It can be due to excessive tear production or due to disturbance of the tear drainage system. Excess production occurs when the eye particularly the cornea, is irritated by a foreign body or surface abrasion.

The tears are collected in fine channels in the inner corner of the eyelids and then drain into a small sac (the lacrimal sac) from there the tears drain via a canal within bone (naso-lacrimal duct) into the nasal cavity.

How does Watering Eye occur ?

Disturbance of the eyelid position causes watering because the tear ducts are turned away from the tear "lake". This is called ectropion. Turning in of the eyelid (entropion) also causes watering due to the eyelashes rubbing against the eye surface. The fine collecting channels can become narrowed or blocked by inflammation and scarring. The tear duct (nasolacrimal duct) can become blocked due to infection. This results not only in watering but also a sticky discharge. This is due to mucus becoming stagnant in the lacrimal sac. Infants may be born with a tear duct which has failed to open. This is quite common.

Treatment Involved

Infants with watery and sticky eye from birth usually get better within a few months. It is important to encourage opening of the nasolacrimal duct by massaging the area over the lacrimal sac. The sac is situated just blow the lower eyelid at the side of the nose. Massage is done 2-3 times a day and may produce a sticky discharge that has been trapped in the sac. A few infants fail to improve by the age of 12 months and should then be considered for treatment. This involves probing and dilating the tear duct under a short general anaesthetic.

Watering of the eye is a common problem in adults. This may be due to the positioning of the lower eyelid (ectropion) which can be corrected by a small surgical procedure. However the majority of cases are due to obstruction of the lacrimal canaliculus in the inner corner of the eyelids or due to obstruction of the duct deeper in the system which passes from the sac to the nose. To establish at which level the obstruction has occurred it is necessary to examine the tear channels under local anaesthetic. A fine probe is passed into the tear duct in the eyelid to establish the patency of the canaliculus into the sac. If this canal is just narrowed and not completely blocked it may be possible to improve the symptoms by dilating it with a larger probe. However if it is completely blocked surgery will be necessary. If the probe enters the sac readily the obstruction is considered to be deeper at the level of the nasolacrimal duct. Fluid syringed into the sac will fail to enter the throat and regurgitate.

If surgery is being planned an x-ray examination of the lacrimal system is normally recommended. A dye is injected into the system which shows upon x-ray highlighting the exact point of obstruction or narrowing. The operation is called a DCR (dacrocystorhinostomy). It involves opening the lacrimal sac and making a new opening in the bone at the side of the nose. The tears can then flow straight to the nose, bypassing the blocked duct. If the canaliculus is blocked a separate channel (an anastomosis) is made in addition (canniluculo-DCR). A plastic tube is left in the system for at least 3 months. The operation can also be done using a laser to make the opening in the bone. The operation is then achieved through the nasal cavity and does not result in an external scar on the side of the nose. The success rate of the external operation however is currently better long term.

After Treatment of Watering Eye

Surgery should completely cure infants, and there is no need for follow-up. In adults, surgery is generally only performed for significant watering, and the patient needs to be reasonably fit. It is a big operation and the success rate is less then 100%.

If Watering Eye is Left Untreated

Continued watering of the eye can often be tolerated. Recurrent infections can also be treated. If the sac becomes infected it can swell up and cause significant discomfort. Systemic antibiotics will then be necessary and sometimes surgical drainage of the lacrimal sac.