Watering Eye / Tear Duct Treatment

Tears normally drain through tiny openings at the inner corner of the eyelids, into the tear sac and then down a duct into the nose. An eye waters when too many tears are made or when they cannot drain away.

• Too many tears: irritation from wind, smoke or cold, dry eye, allergy, infection, or an eyelid that turns in or out.
• Poor drainage: a blocked tear duct. In adults this can follow long-standing sinus problems, a facial injury or previous nose surgery.
• In babies, the duct may not be fully open at birth. This often clears by itself during the first year.

Get urgent attention for a painful, red swelling at the inner corner of the eye, especially with spreading redness, pain on moving the eye or any change in vision. An infected tear sac can spread to the tissues around the eye.

• An examination of the eye and eyelids, to look for irritation, dry eye or an eyelid problem.
• Syringing: a little salt water is gently flushed into the tear-duct opening. If it does not reach the nose and throat, the duct is blocked.
• In babies, a dye test to see whether coloured drops drain away.
• Occasionally, a scan or a dye X-ray of the tear duct.

• Babies: gentle massage over the tear sac and observation at first. If the blockage persists, the duct can be opened with a fine probe, often between 9 and 15 months of age.
• Adults with a blocked duct: dacryocystorhinostomy (DCR) creates a new drainage route from the tear sac into the nose, bypassing the blockage. It is done either through a small cut at the side of the nose (external DCR) or through the nose with no skin cut (endoscopic DCR).
• When the small tear canals themselves are badly damaged, a small glass tube (Jones tube, CDCR) can be placed to drain tears into the nose. The tube is permanent and needs occasional cleaning in clinic.
• If the watering comes from irritation or an eyelid problem, that cause is treated instead.

• Usually under general anaesthetic, occasionally local. It takes about an hour.
• A thin silicone tube is often left in the new passage while it heals, and removed in clinic a few weeks later.
• Some patients go home the same day; others stay one night.

• Eyelid swelling and bruising usually settle within two to four weeks.
• Minor nosebleeds are common in the first days. Avoid blowing your nose for about 7 to 10 days.
• Avoid strenuous activity and swimming for about two weeks.
• Skin stitches after external DCR are removed after 7 to 10 days, and the silicone tube after about six to eight weeks. The eye may keep watering until the tube is out.

Every operation carries some risk. Your doctor will go through the risks that apply to you before you decide.

• Nosebleeds and infection.
• The silicone tube can slip out of place.
• The new passage can scar over and the watering can return. A repeat operation is sometimes needed.
• After external DCR, a small scar beside the nose, which usually becomes hard to see after a few months.
• A Jones tube can move or come out and may need to be repositioned or replaced.