For many people crying is not synonymous with having any psychic or physical pain, it is simply an everyday occurrence, sometimes even disabling for their daily activity. This is due to the fact that the volume of tears produced is greater than can be eliminated by the normal excretory pathway.
Why the tear duct becomes blocked and watery eyes are produced
A healthy person produces tears to nourish and repair the surface of the eye, and these are eliminated through the tear duct, which starts at the lacrimal puncta located in the inner third of the eyelids. From there the tear flows through the lacrimal canaliculi to the lacrimal sac and from there to the nose through the nasolacrimal duct. However, this circuit can become obstructed. In adults it most frequently occurs at the junction between the lacrimal sac and the nasolacrimal duct and, in infants, at the point where the nasolacrimal duct drains into the nostril.
Some patients, due to different pathological processes such as ocular allergies, corneal wounds or other health problems, produce an excessive amount of tears that cannot be eliminated through the tear duct, presenting a more or less constant tearing. A thorough ocular examination will allow the Ophthalmology specialist to identify this excess tear production and prescribe the necessary treatment.
Other patients present a totally correct tear production, or even decreased, with a total or partial obstruction of the drainage pathway. These patients present a more or less disabling epiphora, depending on the degree of obstruction and the amount of tears produced. It is these patients who may benefit from surgery to reopen the tear duct.
Causes of epiphora or watery eyes
The causes of tear duct obstruction are poorly understood. It is known to be more common in women over 40 years of age and, therefore, hormonal problems and makeup problems have been postulated, but no clear relationship between these factors and epiphora has been demonstrated. As we have said, the treatment for these cases is surgery.
Surgical treatment of epiphora
Epiphora surgery is performed with laser. This technique is based on the creation of a communication between the lacrimal sac and the patient’s nostril. This communication is made through the existing tear duct, thus avoiding the unsightly scars that occur when performing the classic surgery. This technique allows the intervention to be performed under local anesthesia, without sutures and with a quick recovery of the patient.
There are other techniques to repair epiphora, although all of them are based on reconnecting the tear duct with the nose. These surgeries are performed in the external or classic way by ophthalmologists, and require a more or less wide wound to reach the bone of the nose, which must be perforated to achieve a new drainage. In the internal route, used by otorhinolaryngologists, the external wound is avoided, but general anesthesia is required due to the maneuvers that have to be performed inside the nostril to perforate the nasal bone.
Epiphora in newborns
A special case of epiphora is the one that occurs in newborns, more common in premature babies. Many of these cases resolve spontaneously in the first months of life but, in some of them, surgical maneuvers are necessary to achieve the correct tear drainage function.
The first maneuver performed to open the lacrimal duct is probing. This resolves more than 95% of the cases. And, in cases of failure, this maneuver can be repeated up to three times, increasing the number of successes. In the most refractory cases, drainage tubes are placed for variable periods of time and, if these maneuvers also fail, the surgical techniques described for adults should be performed.