Watering of the Eye

Watering from the eye is a common symptom. It can be caused by myriad of conditions including emotions. The common causes are either due to increased production of tears or deficient drainage of tears. Increased production is due to dryness of the surface of the eyes, infections of the conjunctiva or cornea, allergies or a small foreign body on the eye. The drainage may be hampered either due to a block along the course of the drainage system or due to a failure of pumping mechanisms.

What is chronic Dacryocystitis / blocked NLD?

The eye has its drainage system called the lacrimal drainage system. A block along the drainage system is referred to as nasolacrimal drainage obstruction (NLDO). Following a block the accumulated tears may be a nidus for infection and when infected the condition is called acute dacryocystitis. When the infection is low grade then there are changes within the walls of the lacrimal system and a chronic dacryocystitis occurs.

How is block in the drainage system negotiated?

Treatment of NLDO is done by surgery. In cases where there is acute infection, surgery is deferred till the initial infection is controlled.

Why is it important to operate on the blocked drainage system before any eye surgery?

Prior to any eye surgery it is important to have a clean and functioning drainage system. A blocked drainage system can create an environment where infections are prone and in this setting eye surgeries can potentially be infected.

Currently the recognized modalities of treatment are conventional external DCR (where an incision is made near the inner end of the eye and a bony window is made by cutting a circular opening in the nose bone and communication is made to the nose), nasal endoscopic DCR (where an endoscope is used to make the opening in the nose) and laser assisted endoscopic DCR (where a fine fibre optic cable with laser is used to make an opening in the bone).

Which procedure to choose?

Every procedure has its own merits and demerits.

External DCR has the highest success rate among all procedure and is still the gold standard procedure for NLD blocks. However the drawbacks is that it is a longer procedure, will have an incision over the inner aspect of the lid though inconspicuous and will need overnight hospitalization.

Nasal Endoscopic DCR is a “no scar “procedure and is a little faster than external DCR. The drawbacks are that the failure rates are a little more than conventional surgery, overnight hospitalization is essential and repeated visits to the hospital is mandatory.

Laser assisted Endoscopic DCR is the latest technique and is the fastest to perform with no scar or hospitalization. However the failure rates are the highest and repeated follow-ups are mandatory.

However your consultant will assist you in selecting the best procedure suited for you.