Wipe away your tears

DR. ARAVIND P. M. DR. SURYAPRAKASH R. DR. VENKATA MADHAVI 

 

 

Are your eyes constantly watering? It's time to see a specialist

 

Janaki was shedding tears. Her friend Charu, however, noticed something peculiar. Janaki was neither unhappy nor was she shedding tears from both eyes. But she couldn't help noticing the steady trickle of water from her friend's left eye. 

“Why are you crying?” she asked. Janaki wiped her eye with the hanky and smiled, “I'm not crying! My left eye has been constantly watering for the last six months. My eyelids are glued shut in the morning and I have to wash them clean to open them. So I'm stuck with my constant companion: my hanky.” 

Blocked duct

With Charu urging her to see a specialist, Janaki consulted her ophthalmologist who referred her to an oculoplastic surgeon. “Your tear duct is blocked and you have an infection of the tear sac,” was the verdict. “You'll require surgery to correct it”. 

A common cause for excessive tearing is an obstruction in the tear duct at the level of its opening into the nose. In normal cases, a steady current of tears is constantly passing over the eye and is cleared by the tear drainage system. An obstruction causes a tear traffic jam and the pooled tears overflow from the corner of the eye on the affected side. The stagnant tears are an ideal bed for bacterial growth. Infections in the tear sac can sometimes result in a painful swelling near the eye called acute dacryocystitis. More commonly, the infection is longstanding resulting in an incessant purulent discharge. Swollen lids, pooled tears and matted lashes cause the eye to appear shrunken.

In rare cases, the infection can spread deeper and become life threatening. The infected tear sac can, on occasion, rupture on the skin surface resulting in abnormal tear drainage on to the cheek through a fistula.

Tear duct obstruction affects not only adults but also infants. Babies do not normally produce tears till the first four weeks. Hence any watering from a newborn's eye needs to be examined. 

In children

The tear duct develops late in children and may take some time to open. In some cases, the opening of the duct can be delayed resulting in excess watering and even infections. Such obstructed ducts can be opened by systematic massaging of the tear sac and medication. Sometimes the block does not open and may need further intervention.

Janaki underwent a Dacryocystorhinostomy or DCR, a surgery that creates a bypass channel between the tear sac and the lining of the nose. It is a safe and effective procedure that can be performed comfortably under local anaesthesia. The surgery took just 45 minutes and she found a permanent cure to her problem. Being a local anaesthetic procedure, she was allowed to go home after two hours of rest. A couple of days later, she was back at work; this time without the hanky.