The tearing system is both simple and complex. The tear film is composed of many different critical components, each made by a different eyelid gland/structure. It is designed to coat the eyeball, protecting the eyeball and essential for vision (by light refraction). A smooth tear film not only depends on the tear glands but also on the tear drainage system, which consists of the eyelids and tear drainage duct system. If there is any disturbance of the tear film, patients can experience blurry vision, irritation, and tearing.
Tear Duct Tearing & Epiphora Overview
Patients who experience tearing, or epiphora, either have a problem with tear production or tear drainage, including dry eyes, blepharitis, eyelid malposition (ectropion, entropion, eyelid retraction), nasolacrimal duct(tear duct) obstruction (congenital and acquired).
Increased Tear Production and Dry Eyes
As odd as it sounds, the most common cause of tearing is dry eyes. If your eye doesn’t make enough tears, the lacrimal tear duct gland responds by secreting watery tears that don’t stick to the eye. So despite the tears spilling from your lids, the eye continues to be dry.
Age, menopause, and various inflammatory conditions (including blepharitis or rosacea) can decreased tear production, with resultant eye dryness, irritation, redness. This irritation causes the brain to send signals to make emergency tears (reflex tearing) t your tear ducts. As a result, the dry eye paradoxically tears and becomes watery. The dryness and tearing can fluctuate throughout the day. Tasks (such as reading or watching TV) that cause make someone to focus more and hence blink less will cause the eyes to get more dry, activating the tear ducts. Wind is also a frequent cause for worsening of eye dryness.
The treatment for dry eyes includes:
1) Replacing tears with artificial lubricants which can be bought over the counter,
2) Medications like Restasis that decrease inflammation in tear glands and encourages natural tear production to resume and finally
3) Tear Drain Plugging (punctal plugs) – To learn more about punctal plugs, read Dr. Taban’s article from the Comprehensive Ophthalmology Update.
Read Dr. Taban's article about Punctal Plugs for Dry EyesClick to Read
Lower eyelid malposition and laxity can also cause excess tearing. If the lower eyelid sits too low relative to the eye, tears will well-up behind the lid and eventually run down the cheek. The tears will also evaporate faster because the eye is more exposed. Severe lower eyelid laxity can lead to ectropion, where the eyelid rotates outward. Once again, patients experience a cycle of dry eye and excess tearing. Entropion, on the other hand, causes direct irritation of the eye by lashes poking the eyes. Surgery is usually necessary to correct these conditions.
Another common cause of excess tearing is nasolacrimal duct (tear duct) blockage. Normally, tears are made in the lacrimal gland and drain into the nose through small holes in the nasal portion of the eyelids called the punctum. A blockage anywhere from the punctum to the bony lacrimal canal in the nose can cause the tears to back-up and run down the cheek. An obstruction of the tear ducts may occur due to numerous reasons (aging, trauma, inflammatory conditions, medications and tumors) and cause numerous signs and symptoms ranging from wateriness or tearing to discharge, swelling, pain and infection. At times, it can lead to dacryocystitis (infection of the tear duct system). A complete eye tearing examination can determine the cause of the tearing.
A thorough examination by an ophthalmic plastic surgeon can determine the cause of tearing and recommended treatment. During your consultation with Dr. Taban in Beverly Hills/Los Angeles or Santa Barbara, he will evaluate your eyes and lacrimal system for the cause of the tearing and discuss all treatments available.
What is Tear Duct Surgery?
If the tearing’s cause is dryness or irritation, then that specific problem needs to be addressed. If the tearing or epiphora is related to a blockage in the tear duct drainage system, then surgery is usually necessary. Nasolacrimal duct (tear duct) blockage is treated by a bypass surgery called dacryocystorhinostomy (DCR surgery). A DCR is performed by creating a new tear drainage passageway from the lacrimal sac into the nose, bypassing the obstruction to the tear duct. A silicone stent may be placed temporarily to keep the new bypass passageway open.
Many surgeons perform an external DCR, where an incision on the skin is made in between the eye and nose. Dr. Taban performs DCR surgery from the inside of the nose, endoscopically, not requiring a skin incision, which does not leave a scar and results in much quicker recovery. This approach is called endoscopic (or endonasal) DCR surgery. You can watch a video of endoscopic tear duct DCR surgery performed by Dr. Taban below.
In rare cases, the blockage may be in the canaliculi system. In these rare cases, a permanent bypass tube made of glass (Jones tube) may be necessary, which allows direct drainage of the tears from the eye into the nose.
Read Dr. Taban's article about Blocked Tear Duct Related to Facial Asymmetry & Septal DeviationClick to Read
Before & After Photos of Oculoplastic Surgeries
Where is DCR Surgery Performed?
Surgery is usually performed under general anesthesia in an outpatient surgery center. As with most oculoplastic procedures, the recovery is quick and painless except for a “black eye” for a few days. As discussed earlier, Dr. Taban uses a minimally invasive endoscopic technique (endoscopic endonasal DCR) through the nose without any outside skin incision, with much quicker recovery and lack of scar.
Lear more about DCR surgeries (dacryocystorhinostomy) from AAO.org.
Contact the LA Oculoplastic Surgery Experts!
To better understand the cause of your eye tearing and treatment options available (including possible tear duct blockage needing DCR surgery), contact Dr. Taban to schedule your initial consultation in our offices in greater Los Angeles area (Beverly Hills or Santa Barbara).
Next, read about Eyelid Laceration Surgery.
*Disclaimer: Results vary from patient to patient. Results are not guaranteed.