TEARING DISORDERS

 

Watery eyes and an overproduction of tears can be due to a blockage of the tear ducts

What are Tearing Disorders?

  
 
Tears are produced constantly by the lacrimal gland which is located under the upper eyelid. Tears are essential because they form a thin film that coats the front surface of the eye and prevents it from becoming dry. Normally, tears are quickly drained from the eye through a complex system of channels that lead from the inner corner of the eyelids into the nose. This system of channels is called the lacrimal drainage system. A disturbance of this equilibrium is seen in tearing disorders. Frequently, obstruction of the drainage system is the reason for excessive tearing.

What causes excessive tearing?

Tears are normally drained quickly from the eye. Blockage of the lacrimal drainage system is an important cause of excessive tearing and tends to occur in older people. It is believed that the blockage is due to involutional narrowing of the nasolacrimal duct.

Any ocular irritation due to a variety of causes can also cause overproduction of tears and excessive tearing.  Dry eyes can sometimes set off reflex tearing and result in occasional bouts of tearing.

How do I know if I have a Tearing Disorder?

You may experience tearing and/or frequent ocular discharge. If the blockage is not resolved, stagnation of tears within the tear ducts can lead to dacryocystitis or infection within the lacrimal sac. 

What treatments are there for Tearing Disorders?

If you have an acute infection of the system, antibiotic treatment with drainage will usually be required. After the infection has cleared, the patient will need definitive surgical repair of the nasolacrimal duct obstruction. The operation required is called Dacryocystorhinostomy (DCR), in which a new channel is created to allow tears to drain into the nose again. Specific operations depend on the site of the obstruction. DCR can be done via an external wound or endoscopically as seen in the photo below.

Example :

	No visible external wound.  Stent left in place temporarily to  improve success rates.

Tearing in a newborn baby

A newborn baby may present with a “wet” eye usually at one to two weeks of age. Occasionally, there may be associated mucopurulent discharge. This is usually due to a membrane blocking the drainage of tears into the nose. This blockage usually opens spontaneously within four to six weeks after birth. Massaging the inner corner of the lower eyelid may hasten the opening of the blockage.
 
However, if the tearing persists despite the massage, flushing and probing of the drainage system can be done to perforate the membranous blockage. This is usually done when the child is less than one year of age. The flushing and probing can be repeated if the tearing persists. Persistent tearing despite these measures would require surgical procedures to relieve the obstruction.
 
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