Oculoplastic specialist, Dr. Kenneth Cahill, joins Dr. Suh to discuss a bothersome condition – epiphora, the medical term for watering eyes. Why does excessive tearing occur and what we can do about it? Blocked tear ducts are a major cause of chronic watering.  

Causes of excessive watering

• Overproduction of tears
• Abnormalities of the eyelids (ectropion (outward turning of the lower lid), entropion (in-turning of the lower lid), or lid weakness)
• Blockage of the tear drainage system (nasolacrimal duct)
• Ocular surface irritation (dry eyes, foreign body, allergies)

Tear glands on the upper part of the eyeball produce the tears. The tears will drain into the punctum, the tiny hole at the margin of each lid close to the nose. This opening leads to the canaliculus, the tube that connects the punctum to the lacrimal sac. From there the tears will end up in the nasal cavity. A blockage, temporary or permanent, can lead to excessive watering.

Symptoms of a blocked tear duct

• Tenderness and irritation of the lid margin and eyelid skin
• Crusting along the eyelash line
• Mucus build-up/discharge
• Dacryocystitis - infection of the lacrimal sac

Punctal stenosis is narrowing of the hole that can cause tearing. This can be caused by chronic use of medicated eye drops, changes from the aging process, viral infections, and dermatitis. This is treated by dilating the opening with a probe or by doing a two-snip punctoplasty to enlarge the hole. These can be performed in the office.

Causes of blocked tear ducts

• Chronic ocular irritation
• Age-related changes
• Chronic use of medicated eye drops
• Nasal trauma or polyps
• Chemotherapy medications (5-FU, Taxotere)

Congenital nasolacrimal duct obstructions are not uncommon. Usually these will spontaneously resolve within the first few months. If they do not, a quick probing procedure can open up the system.

To confirm an obstruction of the tear duct system, a probe and irrigation can be done to test for a blockage and to squirt a small amount of fluid into the system to see if it goes all the way through.

Conservative treatments for partial blocked tear ducts would include using an antibiotic/steroid eye drop and a steroid nasal spray.

There are two main surgical treatments. Silicone intubation involves putting tubing into the tear duct system and leaving it in there for 6-12 weeks. Dacryocystorhinostomy (DCR) creates an opening into the lacrimal sac and into the nose bypassing the opening in the  sac that has scarred down. This is performed with local anesthesia (sometimes general anesthesia) as an outpatient surgery. Tearing usually improves within the first week. The most common complications are nose bleeds and failure to improve the tearing. DCRs have a 90-95% success rate.  Conjunctivodacryocystorhinostomy (CDCR), a variant of traditional DCR, utilizes a glass (Jones) tube that is used when the canaliculi have also scarred.

Here is a great resource with videos about the topics in this episode.

To find out more about Dr. Cahill, go to his practice's website - Ophthalmic Surgeons and Consultants of Ohio.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.