Persistent Watering from the Eyes - LASER gives you a solution!

Tears are produced by several glands around the eye.


The eye's tears are composed of three layers: oil, water and mucous. The outermost oily layer is produced by glands that line the edge of the eyelids. The watery portion of the tear film is produced by the lacrimal gland. This gland lies underneath the outer orbital rim bone, just below the eyebrow. The mucous layer comes from the conjunctiva (the tranparent mucous membrane covering the white portion of the eye.)

With each blink, the eyelids sweep across the eye, spreading the tear film evenly across the surface. The blinking motion of the eyelids forces the tears into tiny drains found at the inner corners of the upper and lower eyelids. These drains are called puncta (plural for punctum).

The tear film travels from the puncta into small tubes called the upper and lower canaliculus, which empty into the lacrimal sac(a small sac in the inner angle of the eye). The tears drain from the lacrimal sac into the nose through a tube called the nasolacrimal duct. This connection between the tear production system and the nose is the reason your nose runs when you cry. Some patients can actually taste eye drops as they drain from the nasal passage into the throat.

Excessive tearing can be caused by several factors; either too much tears are produced and the eye is unable to drain them quickly enough, or the drainage system for the eye is blocked. Some common cause of excess tearing are:

clogged tear duct

environmental irritants, including smog or chemicals in the air,

exposure to hot wind, strong light, blowing dust, or airborne allergens

blepharitis -- dandruff like substance on the eyelids that disrupts tears

conjunctivitis (often accompanied by itching or redness)

foreign bodies and abrasions

allergy to mold, dander, dust

eyelid turning inward or outward

Watering of the eyes caused by blockage of the drainage system of tears is a relatively common condition, particularly amongst the elderly. Dacryocystitis is a term used to describe the inflammation of the tear sac (lacrimal sac) at the inner corner of the eye.When the lacrimal sac does not drain, bacteria can grow in the trapped fluid. This condition is most common in infants and people over 40 years old. Causes and symptoms In newborn infants, the nasolacrimal duct may fail to form an opening--a condition called dacryostenosis. The cause of dacryocystitis in adults is usually associated with inflammation and infection in the nasal region. Dacryocystitis can be acute, having a sudden onset, or it can be chronic, with symptoms occurring over the course of weeks or months. Symptoms of acute dacryocystitis can include pain, redness, tearing, and swelling at the inner corner of the eye by the nose. In chronic dacryocystitis, the eye area may be swollen and watery, and, when pressure is applied to the area, there may be a discharge of pus or mucus through the punctum. To identify the exact location of the blockage, an x ray can be taken after a dye is injected into the duct in a procedure called dacryocystography. Treatment Conservative management: In infants, gentle massage of the lacrimal sac four times daily for up to nine months can drain the sac and sometimes clear a blockage. As the infant grows, the duct may open by itself. If the duct does not open, it may need to be dilated with a minor surgical procedure. In adults, a warm compress applied to the area can help relieve pain and promote drainage. Topical and oral antibiotics may be prescribed if an infection is present. Intravenous antibiotics may be needed if the infection is severe. In some cases, a tiny tube (cannula) is inserted into the tear duct which is then flushed with a sterile salt water solution (sterile saline). Surgery Treatment of dacryocystitis with antibiotics is usually successful in clearing the infection that is present. If there is a permanent blockage that prevents drainage, infection may recur and surgery may be required to open the duct. If left untreated, the infected sac can rupture, forming an open, draining sore. DCR (Dacryocystorhinostomy) is an established successful surgical option for those plagued with tearing disorders caused by blockage or excessive tearing not solved by traditional dry eye therapies. Dacryocystorhinostomy is the surgical procedure wherein an artifical passage is created between the lacrimal sac and the nose to facilitate the draingae of tears.. It can be, · External DCR surgery · LASER DCR External DCR Surgery A small incision is made on the side of the nose to gain access to the tear sac. A little bit of bone between the tear sac and the nose is removed in order to reach the inside of the nose. The tear sac is opened and stitched to the lining of the nose so a direct passage is made between the sac and the nose. The stitches are removed one week after surgery but the procedure may leave an external scar on the side of the nose. This kind of surgery is a difficult procedure and is often also time consuming. It can be associated with pain and bleeding and a slower recovery especially in older patients with the use of anaesthesia. Hospitalization may be required in some patients. Recurrence of the block can also occur requiring further treatment.

LASER DCR

Laser DCR is a state-of-the-art minimally invasive procedure used to correct blockages of the natural drainage system of the eye. It offers several advantages over the conventional surgical approach especially for the elderly as it is a quick, safe and relatively painless procedure. In this procedure, numbing anaesthetic drops are instilled in the eye. A small probe is inserted into the punctum (the natural small openings on the lid margin which drain the tears), advanced till it reaches the drainage sac and the laser filament threaded through the probe. Direct visualisation of the laser tip through an endoscopic closed circuit television system helps the surgeon to fire the laser at the obstruction in the drainage passage to relieve it. Laser DCR is a simple and extremely short procedure taking only a few minutes for completion- on an average 5 to 10 minutes. There is no visible scar as no skin incision is required for the procedure. Laser DCR is associated with virtually no pain or bleeding as it is a minimally invasive procedure with the least trauma to the tissues. It needs no anesthesia (injection) and can be performed with anaesthetic drops itself. Laser DCR is also a much safer treatment option especially for the aged as it can be performed as an outpatient surgery and generates minimal intra and post surgical morbidity. This procedure is also associated with a lower recurrence rate.

CONVENTIONAL DCR LASER DCR     Anaesthesia is by local infiltration (INJECTION) and mild sedation Topical anaesthesia (ONLY DROPS- NO INJECTION)     Surgery is a must No surgery     Excessive bleeding Bloodless procedure     Suturing is a must No suturing as the procedure does not involve any skin incision     Skin scar inevitable No scar as the procedure is performed by LASER     Lengthy convalescence Short recovery time- minimally invasive procedure     Time consuming surgery which can be painful Faster and safer procedure especially in the elderly

Don't let persistent watering bother you any more. LASER DCR is a simple and effective solution to your chronic problem.

Dr. K. Premraj, M.S., D.O., Vision Experts. 120A, Bazaar Road, Saidapet,Chennai -600 015.