ARE YOU SUFFERING FROM WATERY EYE?
Watery eye or teary eye is relatively common. It can occur in any ages. Whilst many associate it with allergies or conjunctivitis, the causes may be many and sometimes multifactorial. The severity ranges from those with welling of tears in the eyes to those complained of excessive eye watery until their lifestyles are severely affected by tears. People complains of inability to see clearly to drive or read , experiences social embarrassment as ‘cry ‘ in a not appropriate circumstances.
Causes of watery eyes:
a) Hypersecretion: Irritation of eyes secondary to blepharitis, conjunctivitis, trichiasis.
b) eyelid misalignment: Entropion (eyelid turning in) or ectropion (eyelid turning out especially punctal ectropion.
c) Obstruction of outflow: canalicular block or blockage of nasolacrimal duct.
There is a big variety of causes associated with this condition. It can be divided into overstimulation and under -drainage.
Causes of too much tear production include blepharitis, eyelid malposition such as ectropion or entropion (eyelid turning in or out) , trichiasis ( misdirected lashes) or epiblepharon ( fold of lashes touched onto eyeball). Another cause of watery eye is dry eyes as neural stimulation sent from dry eye to the brain will cause more tears being produced as compensation.
For the pathologies which lead to under-drainage, that include punctal stenosis (blockage of drainage holes in the eyelid), canalicular obstruction, lacrimal sac stones or tumor or most commonly nasolacrimal duct obstruction.
It is important to note that watery eyes can also occur in children. Epiblepharon is high up in the list of causing the watery eye in Malaysian population that Dr. Ho Shu Fen see. Parents need to be observant and will note that the lower eyelashes that close to the nose rolls in and touch the cornea. As usually the eyes involved become a bit insensitive, patient may not complained. If left untreated, it may be associated with corneal scarring and ambloypia.
Depending on the causes, the treatment of watery eye ranges from eyelid hygiene for blepharitis, tears supplement for dry eyes, epilation or electrolysis for triachiasis, surgical correction for entropion/ectropion; 3 snip procedure /punctoplasty for patient who has punctal stenosis and dacryocystorhinostomy (DCR) for patient with blocked nasolacrimal duct.
DCR surgery is a day care procedure in which a new passage is formed between punctal in the eye and the nose. It is a day care procedure but require general anesthesia. In the end of the surgery there will be a tiny tube which only visible on close inspection. The DCR tube stent will be removed after 6 weeks.
For those who has injury to canaliculus secondary to injury or infection, a Lester Jones tube is a possibility to restore the function.
Immediately post op wound
One month post surgery with hardly visible wound
Entropion wound with lashes curled inside (no lashes visible but poke into eyes)
Post op with all the lashes curled out. The scar will slowly fade.
Pre op: This lady presented with a lump and watery eye
Post op: This lady has a DCR on the right side of the nose, histology showed angiolymphoid hyperplasia. The wound healed well and there is no known recurrence
Pre op: left watery eyes with tear pouring out
Post op: Both eyes look good with minimal visible scarring
Pre op: left nasal lump.
Post op: Post left DCR. Noted minimal scar.
Post op: left oblique view: Note minimal scar.
Post bilateral external DCR , note minimal scar. A well placed DCR scar is not a major cosmetic issue for most patients.