Tearing eyes represent an important part of the consultations seen in Ophthalmology services. Although it may seem a banal pathology, it is not so for the sufferer and, although it does not generate serious repercussions for the individual’s health, it can be extremely disabling for the patient, with important psychological and occupational consequences.
Structure of the lacrimal ducts
The lacrimal ducts comprise the lacrimal lake, located on the surface of the eye; the lacrimal puncta, through which the tears enter and subsequently pass through the upper and lower lacrimal canaliculi that lead to the lacrimal sac. The latter narrows and forms the nasolacrimal duct, which crosses the bone and ends in the nasal fossa. An abnormality anywhere along this pathway can delay or block tear drainage and cause watery eye.
Occasionally, watery eyes are accompanied by signs of infection such as recurrent conjunctivitis, discharge from the eye and eyelashes and even with dacryocystitis, which are severe infections of the lacrimal sac that generate great inflammation, significant pain and general discomfort.
Diagnosis and treatment of lacrimal duct pathology
To determine the site of the lacrimal obstruction we will perform some diagnostic tests: probing and irrigation of the lacrimal duct with a cannula, instillation of drops of a dye in the eye and observation of their passage towards the nose and we can even perform radiological tests to show us the path of the contrast.
If there is a pathology of the lacrimal duct that justifies the lacrimation, the treatment will depend on the site of the obstruction. Surgical treatment is almost always necessary and can be performed under local anesthesia on an outpatient basis. Sometimes it is the lacrimal points that are closed or very narrow and do not allow the tear to enter the circuit. In this case the treatment will be a punctalplasty, that is to say, small cuts in the lacrimal puncta that will widen the orifice through which the tear enters the canaliculi.
When the obstruction is lower, we must resort to dacryocystorhinostomy, which consists of internally joining the lacrimal sac with the mucosa lining the inside of the nose, thus creating a new drainage route for the tears. The classic approach for this procedure is external, from the skin, so it is called external dacryocystorhinostomy. In recent years there has been innovation in this field, with the appearance of minimally invasive techniques, in which surgery can be performed from the nose or by laser from inside the lacrimal canaliculus, thus eliminating the skin wound and greatly reducing surgical trauma.
In cases where conventional techniques fail or the obstruction is not amenable to treatment, the implantation of a glass tube that joins the inner part of the lacrimal lake or caruncle with the nose, thus creating a direct communication for tear drainage, the lacorrhinostomy, is resorted to.