Many people worry or have been told incorrectly they have a blocked tear duct, but this is the cause of watering in only a minority of patients.
There can be many reasons for a watery eye and a thorough eye examination is essential to get to the root cause.
To cure a blocked tear duct requires an operation called a dacryocystorhinostomy (or DCR for short). This creates a new passage for tears to flow from the tear sac to the nose, for the treatment of watery eyes where obstruction of the nasolacrimal duct is the cause. It may be performed through a skin incision (external DCR) or through the nose (endoscopic DCR). I will always aim to perform the procedure entirely within the nose, unless I inform you otherwise at your consultation.
My audited objective success rate is 100% and every week I perform at least two of these surgeries.
All surgery carries risks and benefits. It is for you to weigh up the risks and benefits before deciding to proceed.
What are the benefits?
• improve symptoms of watering eye and sticky discharge
• reduce the need to wipe eyes.
• improved blurred vision from excess water.
Are there any alternatives to surgery?
If you choose not to have this surgery, the symptoms of tearing are unlikely to improve spontaneously and may worsen. This will not, however, have any permanent detrimental effect on your vision or general health although there is a small risk of infections developing in the tear sac that will require medical treatment.
What are the risks?
• nose bleeding – typically settles within first 48 hours
• some swelling is common, typically settling within 2 weeks
• infection – rare, but a risk of any operation
• failure or recurrence of symptoms in the future – 3% of patients
• partial or no improvement of symptoms
• the need for a skin incision and visible scar initially (possibly long-term) if the external approach is used
• scarring in the nasal cavity
• problems related to the tubes (movement or loss of tubes)
• problems breathing through the nose following surgery
• It has been reported that 1 in 1000 procedures may cause a temporary cerebrospinal fluid leak (leakage of fluid of the brain) – I have never heard of or seen this complication during my years of practice in the UK.
In addition to the risks specific to the individual procedure, there are also general risks, such as blood loss, infection, cardiac arrest, airway problems and blood clots, which are associated with any surgical procedure. Local anaesthetic may cause bruising or possible allergic responses. If your operation is to be carried out under general anaesthetic, the anaesthetist will discuss this with you.
There are many other causes of a watery eye. Sometimes correction of a narrowed or closed lacrimal punctum (the plughole itself!) as a 5 minute procedure (punctoplasty) can be all that is required.
My book chapter: The Great Debate: External versus Endonasal Dacryocystorhinostomy. In “Principles and Practice of Lacrimal Surgery”, Ali MJ (ed). Springer, 2014, pp 351–358.
For further information visit the British Oculoplastic Surgery Society website: www.bopss.co.uk