Why can a blocked tear duct cause a watery eye?
Tears normally drain from the inner corner of the eyelids through a fine drainage system into the tear sac and then down the nasolacrimal duct into the nose. If this pathway is narrowed or blocked, tears may overflow onto the cheek. Some patients may also develop sticky discharge or infection of the tear sac.
What is dacryocystorhinostomy (DCR)?
Dacryocystorhinostomy — usually shortened to DCR — creates a new drainage pathway between the tear sac and the inside of the nose, bypassing the obstructed nasolacrimal duct. DCR can be performed externally through the skin or endoscopically from within the nose.
Joint surgery with Mr Mike Mota
Mr Omakobia performs DCR surgery jointly with Mr Mike Mota, BM BSc(Hons) FRCOphth, Consultant Ophthalmologist and Oculoplastic/Orbital Surgeon at East Kent Hospitals University NHS Foundation Trust. Mr Mota completed advanced oculoplastic training at Oxford followed by a fellowship in Oculoplastic and Orbital Surgery at Leicester. His current public profile includes watery-eye and lacrimal practice.
This combined approach brings together expertise in both sides of the tear drainage pathway: the eye and lacrimal system, and the nasal cavity where the new drainage opening is created.
Who may benefit?
- Persistent troublesome watering (epiphora) caused by confirmed tear drainage obstruction
- Sticky discharge associated with tear stagnation
- Previous episodes of dacryocystitis, where appropriate
- Patients in whom endoscopic DCR is considered the most suitable surgical approach
Assessment
Not every watery eye is caused by a blocked nasolacrimal duct. Ophthalmic assessment is therefore important to confirm the cause. Depending on the clinical situation, this may include examination of the eyelids and ocular surface, testing or irrigation of the tear drainage system and assessment of the nose. Nasal endoscopy may be used to examine the intranasal anatomy.
How is endoscopic DCR performed?
The procedure is performed through the nostril using a nasal endoscope, avoiding a skin incision. An opening is created between the lacrimal sac and the nasal cavity so that tears can bypass the blocked duct and drain directly into the nose. A fine silicone stent may be used in selected cases while the new opening heals.
Benefits and limitations
The aim of DCR is to reduce troublesome watering and, where relevant, recurrent tear-sac infection. Outcomes are generally favourable, but no operation can guarantee complete resolution of watering because excessive tear production, eyelid position or narrowing elsewhere in the drainage system may also contribute.
Risks
Potential risks include bleeding, infection, scarring or narrowing of the newly created drainage opening, displacement or irritation from a stent if one is used, persistence or recurrence of watering and the possibility of further treatment. The ophthalmic and nasal risks relevant to your individual case are discussed as part of consent.