 |
 |
 |
 |
 |
 |
 |
 |
 |
The Watery Eye
What is Corneoplastics?
This describes the integration of the external eye with the eyelids. The cornea and eyelids share complementary functional roles, and have important roles in the maintenance of the ocular environment. Therefore, it includes the anterior segment of the eye, cornea, the conjunctiva, and the eyelids and the tissue surrounding the eye and eyelids (EyePlastics), including the tear drainage system. In a broader sense, it also includes disorders of the skin that directly affect the eyes.
The cornea must be clear to maintain sight. Corneal clarity depends on a healthy external environment, free of disease. The eyelids and external eye are vital in maintaining a healthy and clear cornea, allowing normal vision.
Corneoplastics encompasses medical and surgical management of diseases of the cornea such as corneal dystrophies, scarring and keratoconus, and diseases of the conjunctiva and eyelids such as scarring, watery eye, entropion, ectropion, scarring of the face and eyelids, droopy eyelids, tumour surgery, correction for droopy brow, seventh nerve palsy, and reconstructive surgery. It also includes other procedures such as cosmetic face and brow lifts and correction of problems arising from such surgeries.
In this issue, I will address a very common problem of the watery eye.
Watery Eye
Watery eye, known as epiphora, can occur due to a variety of reasons, but typically occurs due to a poor outflow of tears from the front of eye down the tear duct. Tears travel from the front of the eye down the upper and lower tear duct, into the tear sac, and then down the nasolacrimal duct into the nose. This can be seen in Figure 3.
A blockage to outflow can occur along the upper and lower tear ducts, in the tear sac, or in the nasolacrimal duct. Figure 4 illustrates a blockage in the nasolacrimal duct, near it's opening in the nose.
Babies may be born with watery eyes due to incomplete formation of the tear ducts. In younger patients, it is not uncommon to have a watery eye due to a stone located within the tear sac. In older patients, scarring may occur to block the tear duct. Previous nose surgery, injuries, polyps or allergies are risk factors to blockage of the tear ducts.
In most cases, surgery to correct this problem can easily be performed. A relatively common operation called a Dacryocystorhinostomy (DCR) is a tried and proven method with a very high success rate to overcome watery eye due to poor tear outflow. In this operation, a new passage to the side of the nose is created, and it requires removal of bone. The procedure may be performed in 2 ways…the first most common method is from the side of the nose, via a skin incision. This is illustrated in figure 5.
This can be undertaken under local anaesthesia, and has excellent results in routine cases. It remains the gold standard by which other procedures are measured. A second more modern approach involves using an endoscopic light pipe to allow surgery to proceed from the inside of the nose.
This is illustrated in Figure 6. In this case, no skin incision is required. This surgery takes longer, requires a general anaesthesia, and has a slightly higher failure rate. In addition, not all cases of watery eye are suitable for treatment using this approach.
In some cases where the tear ducts are very scarred, neither of these 2 approaches will succeed. To treat watery eye in these cases, a bypass system is available. A glass bypass tube called a "Lester-Jones Tube" is inserted and is a permanent treatment. The tears travel down the bypass tube into the nose. This requires daily care although it does not need to be removed. It may be the only option in severe cases, and provides a dramatic improvement in watery eye.
