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Tears are formed by the lacrimal gland, which lies beneath the outer part of the upper lid, and by cells in the conjunctival surface of the eye. Watering of the eye is a very common but distressing condition for which there a wide variety of causes. People suffering from the condition often face problems in their daily work and home life as others unaware of the impact of the condition think that they are weeping. In general ,the problem results either from an over production of tears or reduced drainage of tears.
The most common cause of over production of tears is blepharitis, essentially an accumulation of debris along the lid margins with resultant inflammation and irritation. This can be treated with regular lid margin cleansing and may require courses of topical or oral antibiotics.
Obstruction to tear drainage can occur at any age but is particularly common with young children. There is a membrane at the lower end of the nasolacrimal duct which will open on its own in over 90% of cases by the age of 12 months. If not, the condition can be cured in 95% of cases by passing a probe along the passageways under a brief general anaesthetic.
In adults the obstruction generally results from a gradual narrowing of the upper end of the nasolacrimal duct, generally from chronic inflammation. Syringing may give temporary relief but is used mainly to aid the diagnosis. Effective and lasting treatment is to make a new passageway for the tears to flow into the nose, bypassing the blocked tear duct. This is a major procedure.
There are two surgical approaches, the external, and the internal approaches. In the external approach the surgeon operates through a small incision on the side of the nose. In the internal approach the operation is carries out with the aid of an endoscope (a pencil thin telescope – like viewing device) passed up the nostril. The external approach has a higher success rate, but leaves a small (12mm) scar on the side of the nose. This scar generally settles very well, and is usually difficult to detect after a few months. The internal approach has a lower success rate in eliminating tearing, but leaves no scar. The external approach can be carried out after the internal endoscopic approach if the internal approach fails. In both the external and endoscopic approaches small silicone tubes are places through the tear ducts to keep the tear passage open during the healing period. These are virtually invisible, and are removed in the clinic at one to three months after surgery.
Complications with this procedure, assuming surgery is carried out by an appropriately qualified oculoplastic surgeon and the patient has followed the medical advice given are infrequent and usually minor. However, all surgery carries a risk, the minor complications that can occur include nose bleeds, bruising, and infection. Rarely a patient may have a heavy nose bleed and require readmission to hospital and further treatment.
Your complete medical history will be required, so check your own records ahead of time and be ready to provide this information. Be sure to inform us if you have any allergies; if you're taking any vitamins, medications (prescription or over-the-counter), or other drugs; and if you smoke.
In this consultation, your vision will be tested and tear production assessed. You should also provide any relevant information from your optician or the record of your most recent eye exam. If you wear glasses or contact lenses, be sure to bring them along.
You will need to follow any guidelines on how to prepare for surgery, including eating, drinking, smoking and taking or avoiding certain vitamins and medications. You may need to arrange for someone to drive you home after surgery and be around to help you out at home if needed for a few days.
Surgery can be carried out under either local anaesthetic with sedation, or under general anaesthetic. It is usually carried out as day case surgery, although some patients prefer to stay overnight.
After surgery your eye will be padded, and the pad is removed the following day. You must avoid hot drinks for 12 hours after surgery, and not blow your nose for one week, in order to reduce the risk of nose bleeds. There is often swelling and bruising of the eyelids (including the other unoperated eye occasionally). This will settle in the following two weeks or so. The sutures are removed at one week and the tubes at one to tree weeks after surgery.