Epiphora – Chronic Eye Tearing

Chronic eye tearing, also known as epiphora, is a condition where tears don’t drain properly, leading to an overflow and involuntary discharge of tears. While epiphora can be caused by a wide variety of issues, epiphora caused by obstruction of the tear ducts can either be primary, meaning with unknown causes, or can be acquired from infection, inflammation, or trauma from facial fractures or facial surgery.

Your eye has a sophisticated system of ducts and sacs that lead to proper drainage of tears from the eye into the nose. Tears are created by the lacrimal gland, located in the outer corner of your eyes. Tears then travel to these small openings on the inner corners of your eyelids, where they drain into a series of tubes called the canaliculus. Tears are then drained into a structure called the lacrimal sac, which is situated by the nose. The lacrimal sac leads to the lacrimal duct, which has a direct connection to the nasal cavity. It’s there in the area of the lacrimal sac and duct that most obstructions that lead to excessive tearing and epiphora occurs.

Diagnosis of Epiphora

Epiphora can be diagnosed by inserting a probe into a drainage channel by the eye to check for blockage. The patient should be under anesthesia while the diagnosis is taking place. Alternatively, another form of diagnosing epiphora is the injection of a liquid dye into the tear duct, which can be seen on an x-ray. This method is used to find blockages that might cause epiphora. Another way to check for blockage is injecting a fluid into the tear duct to see if it funnels through the nose.

Causes of Epiphora and Treatment

Irritation

Infective conjunctivitis, an infection of the tissue that covers the front of the eye, can cause irritation that can lead to epiphora. The usual treatment for this is antibiotics.

Trichiasis

This is actually a fairly common eye condition where the eyelashes start to grow inwards into the eyelid, causing irritation, leading to epiphora. Trichiasis can be treated by an ophthalmologist who can surgically remove any inward-growing eyelashes.

Ectropion

This condition is when the eyelids start to turn outward, which causes the eyelashes and skin to rub against other, causing irritation that leads to excessive tearing. In this case, an ophthalmologist can treat ectropion by surgically tightening the tendon that holds the eyelid in place.

Dacryocystitis

Infections are a common cause of epiphora, and recurring infections in the lacrimal sac is called dacryocystitis. This can be treated by flushing the infection out of the sac and into the nasolacrimal duct. It can also be treated with a regimen of antibiotics, and if this proves ineffective, a procedure called dacryocystorhinostomy (DCR) might be needed to to drain the infection out.

Surgical Treatment for Epiphora

One surgical treatment for excessive tearing is DCR, a sophisticated surgical procedure used to create proper drainage of tears. There are two methods to perform it. In an external DCR, an incision is made between the eye of the nose, the lacrimal sac is found, and an opening to the lacrimal sac is created so tears can drain into the nasal cavity, completely bypassing an obstructed lacrimal duct. For many surgeons and patients, endoscopic DCR is the preferred epiphora treatment because it’s less invasive, has a better success rate, and has less visible scarring. In an endoscopic DCR, an ophthalmologist or otorhinolaryngologist administers a decongestant and inserts anesthesia soaked gauze into the nose to numb the area and constrict blood vessels. An endoscope is inserted into the nose to help with visualization, while bone is removed from over the lacrimal sac to create an opening. This lets tears drain directly into the nasal cavity, bypassing the duct and reducing epiphora.

Houston Plastic Craniofacial & Sinus Surgery specializes in sinus and nasal issues, and is led by fellowship-trained sinus and nasal specialists. For such delicate issues like epiphora, it’s important to trust surgeons as skilled and experienced as the ones at HPCS, who are also board-certified by the American Board of Otolaryngology. Contact HPCS now, for a consultation on treating excessive tearing and epiphora.