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Watery eyes in adults

Surgery on the tear duct to alleviate a watery eye is called lacrimal surgery. If you have a watery eye, it is possible that you have a blocked tear duct.

When you are seen in the clinic, you will be examined to see if your watering is caused by a blocked duct or whether it is happening for some other reason, such as an irritation of the eye causing overproduction of tears. If you have a blocked tear duct and you would like an improvement, it is likely that surgery will be the treatment of choice.

Sometimes a very small procedure is all that is needed but you may require an operation that requires a general anaesthetic either as a day case or with one night's stay in hospital.

For more information about watery eyes in children click here.

Dacrocystorhinostomy

A dacrocystorhinostomy is an operation to alleviate a watery eye. A watery eye is often caused by a blockage of the tear duct which connects the surface of the eye to the nose. The blockage may be at any point from the small holes on the lids (the puncta) to the bottom ends of the main tear duct (the lacrimal duct) Your doctor will have examined you to rule out other causes of a watery eye such as inflammation of the eye or lids and will have determined the likely site of the blockage. If you have a partial blockage, it can be difficult to tell exactly where the block is. If the block is felt to be at one of the holes on the eyelids, a very small day-case operation under local anaesthetic can be performed to enlarge the holes. If the block is felt to be further down the system, a dacrocystorhinostomy is the treatment of choice.

Dacrocystorhinostomy

The operation

A very small incision is made in the skin on the side of the nose adjacent to the corner of the eye. A small hole is made in the bone in the side of the nose and the tear sac is connected directly through the nose. You will have some thin silicone tubing inserted in the system whose purpose is to keep the ducts open and to stop them from healing up postoperatively. (You should not notice that they are there and they can be removed in the clinic about eight weeks later). The skin is then closed with a small nylon stitch.

What to expect post-operatively

Most operations are carried out under general anaesthetic, so you may feel tired after the procedure and wish to stay in hospital for a night. Occasionally you may have a small nosebleed which resolves spontaneously although on rare occasions the nose may need to be packed for 12 hours or so. There is usually only a small amount of bruising around the operation site but this is variable. You will be asked to take some drops four times a day for about two weeks and will probably be given some antibiotic tablets for five days. The stitch is taken out at about a week and the silicone tubes at about eight weeks. The eye may still water whilst the silicone tubes are in place. Take things easy for the first week and avoid heavy exertion.

Don't blow your nose in the first few weeks after surgery.

Don't swim for three weeks.

Complications

Side effects that may occur later include infection of the wound or operation site, but this is rare. A secondary nosebleed may occur at about a week, but taking the antibiotics post operatively will reduce this likelihood. Occasionally the tubes can work their way out at the top end, but can be easily replaced in the eye department using a few drops of local anaesthetic. Unless excessive scarring takes place, the scar from the wound does not usually cause a cosmetic problem and is often very difficult to see.

Success rates

For blockage of the lacrimal duct the success rates are high, about 90–95%. For blockage of the small canaliculi the success rates drop to 60–70%. For partial blockages, the success rates are about 60%.

What if I still have watering after surgery?

Further surgery is possible. The usual cause of failure is a persistent partial or complete block in the tubes at the upper end of the system. You will first be examined to see if the system is still blocked. If there is a persistent blockage you will be examined under anaesthetic to see if a small modification can be made to the operation. If this is not possible, a permanent drainage tube may be inserted at the corner of the eye which connects to the nose. It is important to remember that even if your first operation does not alleviate your symptoms, it is the correct operation because it paves the way for a permanent tube should you need it.

If you have any questions regarding this information, please ask your eye doctor.

 

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