Watery Eye Surgery

There are a number of different procedures that may be required to correct a watery eye which will be discussed with you in clinic.

If you present with a watery eye we may need to syringe your tear duct. The aim is to find out whether or not you have a blockage in the tear system. The syringing is performed using a blunt cannula that is introduced into you tear duct and saline is injected into the tear system.

The aim firstly, is to see whether the cannula can be passed easily along the first part of the tear system (the cannaliculus) and secondly whether the saline will pass down the naso-lacrimal duct into you throat.

You will normally be able to taste some saltiness at the back of your throat.

Not all watery eyes are secondary to a blocked tear duct and in some cases the naso-lacrimal duct may be patent (i.e. saline can reach your throat) but may be narrowed or stenosed. Occasionally further imaging tests are used to identify a stenosed naso-lacrimal duct known as lacrimal scintillography.

If a blockage is identified you may require a DCR procedure. Raji will discuss with you at the time of review the best treatment for your particular problem.

There are numerous procedures aimed at improving your watery eye which depend on the cause of the watering. In over a third of cases a watery eye is related to a blockage in the passage way between the eyelid and the nose. This passage way normally drains the tears from the eye into the nose at which point the tears pass into the throat and is known as the naso-lacrimal or tear duct.

What is DCR surgery?

The standard treatment for nasolacrimal duct obstruction (NLDO) is a dacryocystorhinostomy (DCR) procedure. This effectively bypasses the blockage in the tear duct by making a small hole in the bone on the side of your nose. The tears can then drain into the lacrimal sac and into the nose via newly fashioned pathway

This surgery can be performed either through a small incision on the side of the nose (external approach) or by using specialised endoscopes via the nose (endoscopic approach). Raji will discuss with you the best method for you in clinic .

What happens on the day of surgery?

On the day of surgery you will be asked to come into the hospital to undergo surgery. The surgery is performed usually under a general anaesthetic. If you are coming to stay the night you will need to bring some overnight clothes and toiletries for the duration of you stay. We advise that you also bring in your medications with you when you come into hospital.

What are the risks of surgery?

The risks of surgery include postoperative bleeding, scarring and infection. Nosebleeds are quite common after the surgery and we will monitor this. Rarely, we may need to pack the nose if the bleeding is significant.

The serious risks of the surgery are very rare. There have been reported cases of a CSF (cerebro-spinal fluid) leaks from where we make the hole in the bone and also injury to the eye.

What can I expect after the surgery?

The day after surgery you may have some bruising around the eye and some mild ooze from the nose. We would normally aim for you to be discharged on the first day after your sugery.

What do I need to do after the surgery?

You are advised not to blow your nose for two weeks after your surgery and to refrain from hot beverages for at least 48 hours after you surgery to prevent against further nose bleeds. You should avoid any strenuous activity including lifting heavy objects for a least a week and avoid swimming for three weeks after surgery.

We would aim to remove your stitches at 1-2 weeks. The silicone stent that sits in the nose is usually removed at 4-6 weeks after surgery.

We will give you some oral antibiotics, a nasal spray and an eyedrop to use and the instructions for these will be given to you. The nursing staff will help you with administering these treatments before you leave the hospital.

What is the punctum?

The punctum is the entrance to the tear duct and is found on both the upper and lower eyelid. It is easiest to think of it like a plug hole the which the tears need to drain to reach your tear duct and then your nose.

Why do I need my punctum enlarging?

In some cases the punctum is too small. This may prevent the tears from draining which can give you a watery eye. When punctal stenosis is present we may need to enlarge your punctum by excising a small part of the tear duct. This is called a punctoplasty.

How is a punctoplasty performed?

A punctoplasty is usually performed in the treatment room in clinic. It is performed under local anaesthetic and will take about 5 to 10 minutes. A small piece of the punctum is removed to allow the tears to pass more easily. The tears should then start to drain more easily. This will not usually lead to any visible scar but you may have a small bruise at the inner aspect of your lower eyelid for a few days.

What happens after the surgery?

After the surgery we will review you in clinic and may re-probe the tear duct with some anaesthetic drops. This ensures that the punctum does not close up afterwards. You will have some drops to take for about two weeks.

What are the complications of a punctoplasty?

There are relatively few complications with this surgery. The main risk is that the eye may perstistently water afterwards. As with any surgery around the eye there is a theoretical risk of trauma to the eye or vision.