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Watery Eyes Lacrimal Treatment London

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At a glance:

Watery Eyes Lacrimal Treatment

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Symptoms

watery eyes, sticky eyes, appear to be crying, tearing eyes, overbrimming tears, constantly watering.  

Diagnosis

diagnosed through clinical tests to look at the tear meniscus, lacrimal dilation of the puncta and syringing and probing, and nasal endoscopic examination. A lacrimal scintigraphy, dacryocystogram, or CT scan may be necessary in certain cases

Treatment

medication, minor punctal procedures, Endoscopic Endonasal Lacrimal DCR Surgery or Lester Jones Bypass Tube insertion

Our clinic operates as a private surgery and is not affiliated with the NHS (National Health Service)

 Watery Eyes Lacrimal Treatment London

Watering eyes, also known as epiphora, can be caused by excessive tear production, lacrimal outflow stenosis, or obstruction. There are several different causes.  

The symptoms of watering eyes can vary depending on the cause, with the common one being the production of too many tears that the tear drainage system cannot handle. This causes tears to overflow and run down the face. Other symptoms may include increased sensitivity to light, redness, and eye soreness.  

Blocked tear ducts (a blockage of the lacrimal outflow) can prevent the tears from draining away normally down the tear ducts into the nose, leading to runny eyes.  Or, in more severe cases, it can lead to watery, sticky eyes if there is excess mucous production from within the lacrimal sac. Adults and children can suffer from blocked tear ducts. There can also be a swelling at the corner of the eye close to the nose if the lacrimal sac (part of the tear drainage) is expanded with mucous, called a mucocele.  

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A mucocele of the lacrimal sac can become inflamed and infected as acute dacryocystitis.  

Another cause of watering eyes can simply be a viral eye infection, a foreign body on the eye, a corneal abrasion, or blepharitis, which irritates the eyes, prompting them to produce excess tears. This type of tearing is known as hypersecretion or reflex tears, and there are often telltale signs such as lid margin redness, photophobia, light sensitivity, pain, and/or irritation. In blepharitis and meibomian gland dysfunction, there is often a sensation of watering caused by hypersecretion in response to an actual dry eye. 

All watering can lead to blurred vision as the tear meniscus can be elevated and the tear film can contain a lot of mucous.  

At Clinica London, the Ophthalmologist has to distinguish whether the patient’s watering eye is caused by an excess production of tears or a delay or obstruction of tear drainage.

Of course, it can also be caused by a combination of both: excess tears and poor tear drainage. 

If the cause of the watering is due to a blockage of the lacrimal outflow, where the nasolacrimal duct is severely stenosed or even blocked, and the tears cannot escape naturally to the back of the nose where they are meant to drain to, then surgery is required. 

Where there is lacrimal outflow stenosis or obstruction, surgery to correct it is called  DCR (Dacryocystorhinostomy). If the canaliculi are severely blocked from trauma, drug reaction, or other causes, then insertion of a Lester Jones permanent bypass tube may be required.   

The field of watering eyes, medicine, and surgery is called Lacrimal Ophthalmology or Dacryology. 

Diagnosis for Watery Eyes

The process of diagnosing watery eyes begins with your ophthalmic oculoplastic lacrimal surgeon exploring potential causes such as allergies, eye drops, medications, and physical trauma. Existing conditions such as blepharitis, dry eyes, or nasal and sinus issues could be contributing factors to the narrowing and subsequent blockage of the lacrimal duct, leading to further watery eyes. 

Following your medical history, a comprehensive examination of the area around the eye, the eyelids, and the eye surface will be conducted. This may include a series of clinical tests involving a simple orange dye, punctal dilation and syringing and probing, and nasal endoscopic examination. 

In rare cases, a patient with a partial nasolacrimal duct blockage may need a special radiological test called lacrimal scintigraphy to determine the blockage’s functional level. In some instances, a dacryocystogram or CT scan may be necessary to examine the lacrimal sac’s outline, the orbital bones, the nasolacrimal duct, and the sinuses in the case of trauma or other sinus or orbital disease. 

Treatment Specific

The treatment procedure varies based on the identified cause. It may involve medication, minor procedures, or even surgery, particularly in cases where the issue is due to a more serious condition with a seriously blocked lacrimal outflow (nasolacrimal duct), called DCR (Dacryocystorhinostomy). 

Endoscopic Endonasal Lacrimal DCR (Dacryocystorhinostomy) Surgery 

Endoscopic Endonasal Lacrimal DCR surgery is used when watery eyes are due to Dacryocystitis or a blocked nasolacrimal tear duct. This procedure is an innovative solution for conditions that result in tear drainage obstruction or narrowing (stenosis), causing watering eyes. 

Endoscopic Endonasal DCR surgery is a very precise, delicate procedure that is performed through the nose, creating a new pathway for tears to drain from the eye lacrimal sac directly into the nose, hence bypassing the blocked tear duct. This is achieved using an endoscope, a small tube with a light and camera on the end, allowing the surgeon to see inside the nose. 

The surgery is carried out under general anaesthesia, making it a safe and pain-free option for many patients. As a minimally invasive procedure, it also has the advantages of reduced scarring, less post-operative discomfort, and a quicker recovery time than traditional DCR surgery performed through a skin incision requiring stitches. 

For more detailed information on this procedure, visit our Endoscopic Endonasal Lacrimal DCR Surgery page. 

Lester Jones Bypass Tube

The Lester Jones Bypass Tube is another treatment option for watery eyes, used in cases where the small tear ducts at the corner of the eye are irreparably blocked or damaged by trauma tumours or infection. First of all, an endoscopic endonasal DCR is performed.  

The Jones Tube procedure involves inserting a small glass tube into the new pathway created between the inner corner of the eye and the nasal cavity. This bypasses the very blocked tear duct, allowing tears to drain away normally and relieving the symptoms of watery eyes. 

The Lester Jones Bypass Tube is considered when other treatments, such as DCR surgery, is insufficient for the patient. The procedure is performed under local or general anaesthesia, depending on the individual’s needs and the surgeon’s recommendation. 

While the Lester Jones Bypass Tube can significantly relieve watery eye symptoms, it requires ongoing care and maintenance. Regular check-ups will be necessary to ensure the tube remains unobstructed and functions effectively. 

Preparing for Watery Eye Treatment

During the initial consultation meeting, your surgeon will thoroughly review your medical history and a detailed examination of your eyes on the slit lamp using dye drops. The surgeon will also examine the tear ducts using syringing and probing and nasal endoscopy under topical anaesthetic in order to determine the exact location of the tear outflow blockage.  

If you are pregnant or overweight, your surgeon may suggest postponing the surgery until a safer time. This ensures your well-being and reduces any potential risks associated with the procedure. 

For smokers, it’s recommended to stop smoking at least six weeks before the surgery. This is crucial for reducing the risk of complications and promoting a successful healing process. 

In addition, if you are taking any blood-thinning medications such as Aspirin or Ibuprofen, you should stop taking these at least two weeks before the surgery. 

On the day of your surgery, you should avoid eating or drinking for up to six hours before the treatment. This is a common instruction to reduce the risk of complications during anaesthesia. Surgery is done as a day case. 

Recovery & Aftercare

Following the treatment procedure, you will be required to remain in the hospital until the effects of the anaesthetic have subsided, which usually takes just a few hours.

Post-surgery, some degree of bleeding from the nose is to be expected, but should this become excessively heavy, seek immediate medical attention. To minimise the risk of heavy bleeding, you should refrain from blowing your nose for the first 10 days post-surgery, doing heavy exercise or carrying heavy weights.

Swelling and inflammation may cause the eyes to water for several weeks following the procedure. However, this should subside once the tubes are removed, usually 4-6 weeks post-surgery. Tubes are soft silicone stents sometimes placed at surgery if necessary.

If the patient undergoes external DCR surgery, the eye and side of the nose will be bandaged. These bandages can be safely removed at home the following day. Your surgeon will provide instructions on how to clean and care for the area.

Condition & Treatment for Children

One of the most common causes of watering eye in children is congenital nasolacrimal duct obstruction (CNLDO), which signifies a delay in the maturing of the nose and lacrimal system. Other causes of epiphora include congenital atresias and some craniofacial disorders.

At birth, 50% of nasolacrimal ducts are still not patent. Spontaneous perforation occurs rapidly in the first three to four weeks, meaning that only a few infants have symptomatic epiphora and/or stickiness after birth. Up to 96% of these cases resolve in the first year without intervention, a further 60% resolving in the second year, after which organic resolution continues more slowly.

Sufferers can therefore present with watering eyes during the first days of life, which can cause chronic conjunctival infection, mucous discharge, eyelid dermatitis, or even acute infections in the lacrimal sac known as acute dacryocystitis.

Watering Eyes Treatment with children

Examination

Watering eye in children requires a specialised examination by a paediatric lacrimal surgery specialist in order to exclude absent puncta or canaliculi, as well as to identify mucocele, dacryocele and craniofacial disorders.
Specialised examinations can be carried out, so as to identify the tear meniscus and a test involving blue light and a special dye is done.

Treatment

Conservative management of watering eyes in children requires the parents to understand the natural history of epiphora. They also need to be aware that they should avoid frequent and unnecessary topical antibiotics, except in the case of conjunctivitis. They should also know to wipe sticky eyelids and lashes with cold boiled water.

Lacrimal sac massage

The parent can massage the sac below the medial canthal tendon with a little finger, provided the nail is short. This increases the pressure in the lacrimal system, helping to express fluid and mucous into the conjunctival fornix. Massage may also accelerate opening of the lower end of the nasolacrimal duct.

Syringing and Probing

Syringing and probing are both under general anaesthesia with a laryngeal mask, following a comprehensive examination of the eyelids and puncta. The procedure can be carried out in the children older than ten to twelve months, in which symptoms continue despite the conservative management, unless there is a congenital dacryocele or acute dacryocystitis.

The punctum is dilated, allowing for insertion of a lacrimal cannula and syringe. The nasolacrimal duct is then investigated using probes of a different size. After this point, the membrane is perforated to allow entrance into the nose. A ‘pop’ might be felt but there is usually minimal or no bleeding during this procedure. Clinica London favours endoscopic endonasal monitoring to assess the position of the probe.

Postoperatively, topical steroid-antibiotic drops are used for one to three weeks, depending on the severity of the CNLDO. The patient is then reviewed in clinic in six weeks.

Congenital dacryocele or congenital lacrimal sac mucocele management

Congenital dacryocele is an uncommon neonatal swelling of the lacrimal sac which can become inflamed with acute dacryocystitis leaving the child febrile and ill. It is typically a tense, bluish swelling present at birth or within one to four weeks. Approximately 25% of sufferers have bilateral dacryoceles.

In cases of a quiet dacryocele, massage and warm compresses can be tried first. Congenital dacryocele however is the exception to probing and syringing at one year old as, in these cases, probing is preferable at less than six weeks. In cases of acute dacryocystitis, intravenous antibiotics are administered five to seven days before probing.

Failed probing

If endoscopic endonasal monitoring of syringing and probing fails, the procedure is repeated with silicone intubation. If intubation fails or if the case is complex, a DCR is considered. A similar surgical technique is employed in both adults and child cases, the DCR being either external or endoscopic. It is however preferable to wait until the child is aged two to four years before performing this operation.

Our consultant

Ms Jane Olver is our oculoplastic lacrimal surgeon who excels in tear duct surgery. She specialises in both primary and secondary DCR surgeries, catering to patients with idiopathic watering eyes, complex trauma, prior sinus surgery, and other conditions causing watery eyes. 

Jane introduced EndoDCR surgery in the UK and has trained numerous ophthalmologists, both domestically and internationally, in the evaluation and treatment of watering eyes using endoscopic endonasal DCR surgery. She has written the textbook book called Colour Atlas of Lacrimal Surgery and many more publications and chapters on watering eye surgery.

Miss Ting offers a comprehensive assessment of watery eyes, helping patients to identify all the possible factors that are contributing to their symptoms. She is highly experienced in performing endoscopic dacryocystorhinostomy surgery, canalicular trauma repair, and Lester Jones tube surgery.

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Miss Jane Olver

Consultant Ophthalmic Surgeon
Oculoplastic (Eyelid) & Lacrimal Specialist
Medical Director
President International Society Dacryology and Dry Eye 2024-2026

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Ms Michelle Ting

Consultant Ophthalmic Plastic and Reconstructive Surgeon

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Our clinic operates as a private surgery and is not affiliated with the NHS (National Health Service)

Pricing

For watering eye treatment using the DCR method at Clinica London, prices range from £4200 to £7000. This includes surgeon and anaesthetist fees, hospital fees and the removal of the tubes. This does not include initial consultation fees. 

Please book a consultation to receive a written quote with a detailed breakdown of treatment costs.

Initial consultation fees are not included.

Watery eyes FAQS

Will I need any time off work?

If you have undergone a Dacryocystorhinostomy (DCR) surgery, taking at least 48 hours off work is advisable. Many patients prefer to take around ten days off. 

How long does the treatment for watery eyes last?

The length of the treatment procedure for watery eyes can vary depending on the specific treatment method used. However, procedures such as Dacryocystorhinostomy (DCR) surgery typically last around 1-2 hours. 

Which underlying eye conditions cause watery eyes?

Several underlying eye conditions can cause watery eyes. One of the most common is viral conjunctivitis, also known as pink eye, which is an infection or inflammation of the conjunctiva, the clear tissue covering the white part of the eye and the inside of the eyelids. 

Blepharitis, or eyelid inflammation, is another condition that can lead to watery eyes. It can be caused by a bacterial infection, certain types of skin conditions, or dry eyes. 

Keratitis, or inflammation of the cornea, can also cause watery eyes. This condition can be caused by an infection, an injury to the eye, or wearing contact lenses for extended periods. 

If you are experiencing excessively watery eyes, it’s important to consult a healthcare professional to determine the underlying cause and appropriate treatment. Only certain types of watery eyes require DCR surgery. Most of the above causes of watering eyes are treated entirely medically. 

Blocked nasolacrimal tear ducts can be caused by inflammation ascending the duct from the nose and sinuses, systemic diseases, trauma, and tumours. This type of outflow obstruction causes watery eyes and is treated by DCR.  

Why do my eyes become watery outdoors?

There could be several reasons why your eyes become watery outdoors. 

A common reason is exposure to environmental elements like wind, sun, dust or allergens, which can cause eye irritation and trigger excessive tear production. 

In some cases, dry eyes can also cause watery eyes, as the dryness of the eyes can stimulate the overproduction of tears as a protective response.  

If the outflow is a little narrow, such as nasolacrimal duct obstruction, any excess tear production cannot drain, and the eyes feel watery. 

If you are experiencing excessively watery eyes, it’s important to consult a healthcare professional to determine the underlying cause and appropriate treatment. 

Does Dacryocystorhinostomy (DCR ) surgery hurt?

Dacryocystorhinostomy (DCR) is performed under general anaesthesia, so you should not feel pain during the procedure. However, you may feel some discomfort immediately afterwards, which can typically be managed with over-the-counter pain relievers. 

Can I have watery eye surgery done under local anaesthetic?

Absolutely. Watery eye surgeries, such as Dacryocystorhinostomy (DCR) and the placement of a Lester Jones Bypass Tube, are often conducted under local anaesthesia; however, many patients prefer the initial DCR surgery to be done under a General Anesthetic. Local anaesthesia numbs a specific body area, allowing a procedure to be performed without pain, but the individual remains conscious throughout. This type of anaesthesia is usually preferred in very elderly for its safety and comfort, reducing the risks associated with general anaesthesia. 

The choice between local and general anaesthesia will ultimately depend on your general health, your age, the complexity of the surgery, and your surgeon’s recommendation. Your doctor will discuss the best options with you, considering your particular circumstances, before proceeding with the surgery. 

Award Winning Clinic in London

Clinica London is a leading ophthalmology and dermatology medical clinic. It has a sense of passion for helping patients. The clinic’s consultants are highly skilled professionals who have received British, European, and international awards in their respective fields. Clinica is honest and offers transparent treatment advice in a relaxed and comfortable environment.

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Telephone: 020 7935 7990

International Callers : +44 20 7935 7990

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