THE WATERING EYE. Brigita Drnovšek-Olup Eye Hospital, University Medical Centre Ljubljana, Slovenia. Introduction. Watering eye is an extremely common ocular symptom. Watering eye lacrimation epiphora
Eye Hospital, University Medical Centre Ljubljana, Slovenia
Failure to differentiate these two conditions can result in unwarranted and improper medication of a large number of patients.
Lacrimation is watering that occurs secondary to excessive tear production in the presence of a normal excretory system.
palpebral part (1/3)
Previous reports had vastly underestimated the thickness
Epiphora:(defective drainage): compromise of the lacrimal drainage system:
Primary punctal stenosis (chr. blepharitis, idiopathic primary stenosis, herpetic infection of eyelid, irradiation, cicatrizing conjunctivitis and trachoma, cytotoxic drugs, porphyria cutanea tarda, acrodermatitis enteropathica)
Secondary punctal stenosis (punctal eversion)
Canalicular obstruction (cong., trauma, herpetic infection, drugs and irradiation, chr. dacryocystitis)
Nasolacrimal duct obstruction (idiopathic stenosis, trauma, previous surgery, granulomatous disease, tumours)
Nasolacrimal duct obstruction
Pseudoepiphora: epiblepharon, distichiasis, trichiasis, glaucoma…The lacus is dry and syringing is patent.
Lacrimation secondary to corneal disorders or conjunctivitis is obvious due to associated symptomatology or on examination. Two conditions which can be mistaken for true epiphora are dry eye syndrome and blepharitis.
Dry eye:Dry eye secondary to deficiency of mucous or meibomian secretions can have paradoxical watering. A diagnosis is usually based on reduced lower tear meniscus, and increased debris in tear film on slit-lamp examination. Increased tear break-up time (BUT) and reduced Schirmer's strip wetting corroborate the diagnosis.
Fluorescein disappearance test (no dye after 3 mins)
Probing and irrigation (hard stop or soft stop)
Jones dye testing (the primary and secondary test)
Nuclear lacrimal scintigraphy
Ectropion or entropion - lid repair.
Primary punctal stenosis – dilatation with Nettleship dilatator, punctoplasty.
Secondary punctal stenosis – Ziegler cautery, medial conjunctivoplasty, Lower lid tightening.
Canalicular obstruction – partial: intubation; total: canaliculodacryocystorhinostomy and intubation or CDCR and the insertion of Lester Jones tube.
infants: massage, probing;
adults: DCR, TCL-DCR, intubation, stents, balloon dilatation.
Lester Jones tube
Endocanalicular laser DCR
2. Transillumination of nasal bone.
3. Cauterization of mucosa. 4.Osteotomy and opening of lacrymal sac
6. Haemostasis & tamonade.
7. Osteotomy with stents at end.
8. Open osteotomy 1 mo post-op.