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					The Watery Eye (Epiphora)

                            Additional Notes...




                                                                                                The Watery Eye
                                                                                                (Epiphora)
                                                                                                The Eye Unit




                            Mission Statement
                            The Royal Bournemouth and Christchurch Hospitals NHS
The Eye Unit




                            Foundation Trust strives to provide high quality care through its
                            professional, efficient and patient focused approach.


                            The Eye Unit
                            Royal Bournemouth Hospital, Castle Lane East, Bournemouth,
                            Dorset BH7 7DW


                            Author               Ben Parkin, Consultant Ophthalmologist
                            Date                 July 2007                                      Information and advice for patients
                            Version              2                                              about Watery Eyes
                            Review Date          July 2009
                            Ref. No.             239/07

 07                                 Website www.rbch.nhs.uk | Tel (01202) 303626                     Website www.rbch.nhs.uk | Tel (01202) 303626
                            Why do eyes water?
The Watery Eye (Epiphora)




                                                                                                                                                     The Watery Eye (Epiphora)
                                                                                                 Additional Notes...
                            In order for eyes to stay healthy, they must keep moist.


                            How are your eyes kept naturally moist?
                            A gland in the upper outer corner of the eye makes tears (the
                            lacrimal gland). The tears wet the eye and at the inner corner
                            they drain away into tubes in the upper and lower eyelids
                            (canaliculi).


                            These tubes join and empty into the lacrimal sac, beside the
                            nose. The sac drains into the nose through another larger tube
                            (nasolacrimal duct).


                            This is why you have to blow your nose to clear the extra tears
                            which have drained into your nose when you cry. In watery eyes
                            the plumbing is blocked or narrowed and the tears cannot drain,
                            but spill over the eyelids onto your face causing watery eyes.


                            The medical term for a watery eye is ‘Epiphora’.
The Eye Unit




                                                                                                                                                     The Eye Unit
                            How can a watery eye be treated?
                            If there is narrowing of the opening into the tubes on your
                            eyelid, a simple operation to make them bigger is usually all that
                            is needed, and this is carried out as a minor operation.


                            If there is no blockage found in the plumbing system (known as
                            ‘functional epiphora’), the treatment may be difficult and your
                            surgeon will discuss the options with you.



 01                                 Website www.rbch.nhs.uk | Tel (01202) 303626                      Website www.rbch.nhs.uk | Tel (01202) 303626    06
                                                                                If there is blockage further down, in the nasolacrimal duct, you




                                                                                                                                                     The Watery Eye (Epiphora)
The Watery Eye (Epiphora)

                            Additional Notes...
                                                                                may need a larger operation (DCR) to stop your eye watering.


                                                                                What is a DCR?
                                                                                The operation called a dacryocystorhinostomy (DCR) creates a
                                                                                new pathway for the tears to drain into your nose.


                                                                                We remove some bone between your tear sac and the nose. A
                                                                                tiny plastic tube is threaded between the tear drainage holes in
                                                                                your upper and lower lids and tied inside your nose.


                                                                                The operation is carried out either through your nose
                                                                                (endonasal) or through the skin on the side of your nose
                                                                                (external). Your surgeon will recommend which approach is best
                                                                                for you.


                                                                                How does a DCR help?
                                                                                A DCR will make an eye less watery in 70-90% of patients. Your
                                                                                symptoms may not go away immediately as blood clots may




                                                                                                                                                     The Eye Unit
The Eye Unit




                                                                                block the new route for tear drainage for the first few days after
                                                                                surgery. Even if the surgery works there may be a little eye
                                                                                watering in cold weather outdoors or in a strong wind.




 05                              Website www.rbch.nhs.uk | Tel (01202) 303626           Website www.rbch.nhs.uk | Tel (01202) 303626                  02
                            What can I expect after surgery?                                    • Very rarely, a fracture may spread from the bones at the side




                                                                                                                                                                    The Watery Eye (Epiphora)
The Watery Eye (Epiphora)


                            • You may get some bleeding from the nose after surgery, but          of your nose up to the bone around your brain and cause a
                              usually this does not last long.                                    leak of fluid. If you notice a constant running nose with clear
                                                                                                  fluid following surgery, it is important to contact the
                            • If you have had an external DCR, the stitches are normally          department.
                              removed after 5 days.
                                                                                                What should I do before surgery?
                            • You will be given some antibiotic and steroid eyedrops to be      Please tell us if you are taking anticoagulants (such as
                              used 4 times a day to the eye, and a steroid nasal spray          Warfarin). Stop taking aspirin, and other painkillers such as
                              (Sterimar) to be used twice a day (or as instructed). Treatment   Nurofen or Brufen 3 weeks before surgery unless instructed
                              normally lasts 6 weeks. You may use Sterimar spray more           otherwise.
                              often to help clear the nasal passages if you wish.
                                                                                                When should I contact the department?
                            • The tubes are removed painlessly through the nose in the          • If you have a lot of bleeding from the wound or nose
                              clinic after 1-3 months.                                          • If you have any pain, redness or discharge of the wound
                                                                                                • If you get continuous dripping of clear fluid from the nose
                            To help prevent nose bleeds                                         • If you have any problems with your vision
                            • Sit upright, and sleep with 2 pillows the night after surgery.    • If your eye becomes red or painful
                            • Avoid hot drinks, sneezing and coughing for 48 hours              • If you have problems with the tube at the corner of your eye




                                                                                                                                                                    The Eye Unit
The Eye Unit




                            • Don't blow your nose for 7 days
                                                                                                For further information and advice please contact:
                            What are the risks of DCR?
                            • Unfortunately the surgery does not help in about 10-30% of        Emergency Helpline                 (01202) 704181
                              patients. Another operation may then be needed.                   7 days a week                      8:00am to 9:00pm


                            • Your wound may become infected or break open and your
                              tubes may become displaced and irritate your eye.




 03                                 Website www.rbch.nhs.uk | Tel (01202) 303626                        Website www.rbch.nhs.uk | Tel (01202) 303626                 04

				
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