Watery Eyes (Dacryocystorhinostomy)
Watery Eyes Frequently Asked Questions – London
What causes a watery eye?
A watery eye can be due to many causes. It is essentially an imbalance between the amount of tears being produced by the tear gland and amount that can be removed by evaporation and the tear drainage system. Problems with the eyelid or narrowing of the drainage canals can prevent tears being drained into the nose. Some people have more than one factor causing their watering. Even some people with dry eyes may also experience watering due to reflex tearing as the eye attempts to keep itself moist.
What is a blocked tear duct?
Why does blocked tear duct occur?
How do I know if I need an operation?
What does the surgery involve?
The surgery creates a new pathway between the tear sac and the inside of the nose by removing a small piece of bone between them and bypassing the blocked nasolacrimal duct. This operation is called a dacryocystorhinostomy or DCR for short.
The operation is performed in one of two ways:
- The endonasal approach avoids a skin incision and is performed through the nose using an endoscope.
- If the nasal passage is too narrow the external approach is used, through a 1.5cm skin incision on the side of your nose, where a pair of glasses would rest. This heals up very quickly and in most people is nearly invisible when healing is complete. There will be a stitch, which will usually be removed seven to ten days after the operation.
The success rate of the approaches through the nose and through the skin are the same. Your doctor will tell you which approach is most suitable for you.
In a few patients, a small soft silicone tube or stent is placed in the tear duct/canals to keep the passages open while healing takes place. This is removed 6 weeks after the surgery in the outpatient clinic.
How successful is the surgery?
In most cases where the obstruction of the tear duct is in the nose, there is a 90-95% success rate. This means 1 in 10 people may not improve after surgery.
Rarely if the obstruction is in the tiny tear canals on the eyelid (canaliculi), the success rate is less and can vary between 50-90% depending on the exact site and extent of blockage.
What type of anesthetic is necessary?
The operation takes about an hour and is usually performed under a general anesthetic where you are asleep, or under local anesthetic with intravenous sedation to make you sleepy so you do not feel any discomfort.
You may be able to have the surgery as a day patient and go home the same day or you may be admitted overnight. Your doctor will discuss which will suit you best at your consultation.
What should I do in preparation for surgery?
Is there anything I should not do after the operation?
What happens after surgery?
What is the follow-up treatment?
What are the main complications following a DCR?
Bleeding: A nose-bleed can occur up to 14 days after surgery. This happens to about 1 in 100 patients. In most cases the bleeding will stop by itself or with icepacks, but if it continues or is very heavy you should attend the accident and emergency department at your nearest hospital.
Infection: Infection of the wound or sinuses may rarely occur in 1 in a 100 people usually within the first week and is treated with oral antibiotics. If you develop a temperature or increased nasal or facial pain then seek medical advice.
Failure of the watery eye to improve: This occurs in 1 in 10 people and can sometimes be improved with a second operation.