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Tearing Problems

Ocular Surface Conditions

Watery eyes or excessive tearing is a common problem for which patients present to their ophthalmologist. This can be a very troublesome and inconvenient problem. There are a number of causes of excess tears which are very different in their nature and thus the treatment.

Ocular Surface Disease

For example, numerous conditions related to the health of the surface of the eye such as infection, inflammation, dryness, excess exposure, and scarring can lead to watery eyes.

Eyelid Laxity

Another common problem is that the aging process leads to an increase in the laxity of the eyelids. This eyelid laxity can lead to welling up of tears due to inefficient flow of the tears into the tear drain system. Eyelid laxity is treated similar to Ectropion (see above) with a procedure used to tighten the eyelids. Commonly along with the eyelid laxity, the opening to the tear drain system (called the punctum) is sometimes poorly positioned relative to the area of pooled tears. This is called Punctal ectropion and this condition is surgically treated in conjunction with an eyelid tightening surgery.

Tear Drain Blockage (Nasolacrimal Duct Obstruction)

Another common cause of excessive tearing is blockage of the lacirmal (tear drain) system. In children, this is typically congenital and often resolves with conservative management comprised of massage and medical treatment alone. Occasionally further surgical intervention may be required. In adults, the blockage can be due to a number of causes including inflammation, infection, tumors, or injury. Furthermore, the blockage can occur at a number of different points along the tear drain system. If the blockage is located towards the end of the tear drain (the nasolacrimal duct), a surgery called a Dacryocystorhinostomy (‘DCR’) may be recommended. In this surgery, the point of blockage is bypassed by creation of a new channel for tears to flow from the tear drain into the nose. A small silicone stent is placed in the tear drain system which is later removed.

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