Can't stop crying?

January 2013

January can bring a tear to the eye for many reasons, the thought of a post-Christmas diet, blustery winter walks and perhaps Januarys credit card statement to name but a few.  Consultant eye surgeon Mrs Bridget Hemmant and Consultant ENT Surgeon Mr Peter Prinsley offer other reasons why watery eyes can cause problems for many during the winter months.

Mrs Bridge Hemmant explains:
“If you suffer from watery eyes you may often wonder why your eyes can be watery and damp during the winter. Potential causes include production of too many tears, inflammation of the eyes, foreign bodies, scratches to the surface of the eye and some eye infections”.

Why we produce tears:  “Their main role is to wash away harmful bacteria to moisten and protect the surface of the eye. Without their protective effect the eye would dry, bacteria would take hold and it could become blind from serious infection. Our bodies dispose of tears by both evaporation and drainage from the surface of the eye via tear drainage tubes, whose openings are just visible in the corners of your upper and lower eyelids.

“The evaporation process is temperature-sensitive and therefore, when autumn and winter arrives the evaporation effect reduces, leaving the tear drainage tubes to cope with greater volumes of liquid. Watery eyes, in these conditions, can indicate that the drainage tubes are not working efficiently, overflow and lead to a constant watering all day, every day!

“A common cause of constant watering is poor positioning of an eyelid or a blockage or narrowing of the tear drainage system. Other causes could be injury to the eyelid and some eye infections”.

Bridget looks at two common causes and their treatments: sagging eyelids and poor tear drainage.

Sagging eyelids: “Tears are produced in a gland in the outside corner of the upper eyelid and wash across the surface of the eye propelled by the pumping action of the eyelid muscles. They flow into the drainage system and onwards through the tubes, eventually draining into the back of the nose and throat.

“Under normal conditions, your eyelids deal with tears by blinking. They act similarly to the windscreen wipers on a car as they sweep tears from the surface towards the tear duct openings. Poorly positioned eyelid muscles and sagging skin can disturb this simple process in a similar manner to poorly fitted or loose wiper blades.

“Eyelids are no different from other parts of the body and they can also sag as we get older! Sagging of an eyelid can reduce the efficiency of its pump mechanism and result in one or more of the tear duct openings losing contact with the eye’s surface. In both cases the drainage process fails and tears run down your cheek. These problems are normally correctable with simple day surgery under local anaesthetic by an eye surgeon specialising in oculoplastic and lacrimal surgery”.

Poor tear drainage:  “The tiny openings and the drainage tubes themselves can also become blocked or narrowed so tears cannot enter the drainage system and the only escape route for the tear is, down your cheek. This type of blockage is a common cause of tear drainage problems in adults and will not correct itself. If left untreated, it may result in serious eye infections.

“Lacrimal drainage surgery is often performed using an endoscope (a tiny tube through which the surgeon can both observe and operate) introduced via the nose. In rare cases, better access to the tear duct needs a skin incision. The aim of both types of surgery is to bypass the narrowed or blocked tube by making a new ‘join’ between the tear sac and the lining of the nose”.

Mr Peter Prinsley (Ear, Nose and Throat Consultant) and Eye surgeon Mrs Bridget Hemmant explain that working as a team is the solution. Peter, using the endoscope, gets a clear view of the inside of the nose to gain access to the tear sac and then bypasses the blockage via a new connection. Bridget, working from the eye end, passes tiny clear silicone tubes down through the tear ducts to keep the channel open. These tubes are normally in place for about 3 months before being removed easily in clinic.

Mr Prinsley tells us, “The overall success rate of this process is very good, with most cases working first time and the others, with repeat surgery, also resulting in success”.

Bridget Hemmant advises, “Don’t ignore such symptoms as watery eyes, they are not always simply part of the ageing process and can be cured. If you are affected, you can consult your doctor, and ask if you should see a specialist”.

The content of this page is provided for general information only. It should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professional.

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