for excessive tearingEpiphora Surgery

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Last updated 10/7/2022
Woman with blocked tear duct

What Causes Watery Eyes?

Tears play an important role in keeping your eyes healthy. They help keep the surface of your eyes lubricated, tears also help clear dust and debris from your eyes, they act as a barrier to help prevent eye infections, tears provide a medium upon which contact lenses float, and they play a role in maintaining clear vision.

 

Excessive tearing (known as epiphora) results from an imbalance between the rate at which your body produces and eliminates tears. Epiphora can happen at any age but is most commonly seen in infants and folks over 60. It can affect one or both eyes. 

The main causes of watery eyes

Blockage in the tear elimination system

The most common cause of watering eyes in adults is blocked tear ducts, followed by tear drainage openings that are displaced or too narrow to drain a normal volume of tears. When tears can’t drain away from the eyes properly, they build up and overflow onto the cheek.

 

Tear over-production

Your eyes can produce excess tears when they become irritated by a foreign object, a chemical irritant or allergens. Some medications can also cause excess tearing.

 

Ectropion eyelid malposition

Turning out of the lower eyelid directs the puncta away from the eye so that tears can’t find their way into the tear drainage ducts. Ectropion can sometimes result from an improperly performed eye lift (blepharoplasty) and can lead to dry eye syndrome from inadequate eye lubrication or tears evaporating too quickly.

 

Entropion eyelid malposition

turning in of the eyelid can cause eyelashes and the eyelid rim to irritate or even scratch the cornea with every blink

 

Floppy eyelid syndrome

Laxity in the eyelid muscles due to aging or a facial nerve palsy (like Bell’s Palsy) can prevent your upper and lower eyelids from forming a good seal when they’re closed, leading to tear overflow

 

Trichiasis

Trichiasis is an inward growing eyelash can irritate the cornea, causing tearing


How does the tear drainage system work and what can go wrong with it?

It’s important to review some basic eye anatomy to understand how tears are produced and eliminated from your eye.

 

There are three components to your tear production and drainage system:

 

  1. Tears are produced by glands located just below your outer brow.
  2. Tears then flow out of openings located within your upper eyelids and spread over the surface of your eye in a thin tear film every time you blink.
  3. Tears are also drained away from your eyes each time you blink via pinpoint-sized drainage holes (called puncta) located at the inner corner of your eye along the upper and lower eyelid margin. Each punctum leads to ducts that carry the tears into your nose. This tear drainage system is known as the nasolacrimal duct system or NLDS.

 

What causes tear ducts to get blocked?

Once your tear drainage system gets blocked, your tears have no way to drain and so will spill out onto your cheek. If the NLDS becomes blocked, it can become infected (dacryocystitis) and this can be very painful.

 

There are several ways your nasolacrimal duct system can get blocked, including:

 

  • A common cause of blockage is an age-related shrinking of the nasolacrimal duct.
  • The puncta can become blocked by dirt or dead skin cells, or it can be forced shut by conditions causing inflammation of the eyelid (like a stye). Your eye specialist might instruct you to apply warm compresses and prescription eye drops which may help.
  • The NLDS can also become blocked by scar tissue resulting from trauma that can cause narrowing or total obstruction of the duct.
  • A severe viral pink eye might cause scar tissue to form over the pinpoint opening of the drainage system (called the puncta) located at the inner corner of your eye along the upper and lower eyelid margin. The puncta may require surgery (known as a punctoplasty) to be re-opened once the infection has cleared.
  • A blocked nasolacrimal duct can be repaired surgically through the insertion of a stent to widen the canal or by re-directing the drainage canal through a surgery known as a Dacryocystorhinostomy (DCR).

 

How we treat eyelid deformities and incomplete eyelid closure?

If the cause of your tear overflow is due to a functional problem like an eyelid deformity or weak eye closure, your eye doctor may recommend a surgical correction to restore proper eye closure and tear drainage.

 

As a trained ophthalmologist with a sub-specialty in oculoplastic surgery, Dr. Rafi Israel has decades of experience in treating functional eye problems affecting patients’ vision and eye health. He has performed thousands of procedures to correct eyelid malposition conditions like ectropion, entropion, floppy eyelids, in-grown eyelashes, and lax eyelid muscles.

 

Because each patient has a unique pair of eyes that come with unique challenges, Dr. Israel begins each eye care consultation with a detailed history and eye exam to identify not only the underlying cause of your excess tearing but also how it affects your life. This input will form the basis of the treatment options and medical advice tailored to your needs.

 

Whether you require re-balancing of your eyelid muscles, realignment of a mal-positioned eyelid, or unblocking of your tear drainage system, Dr. Israel approaches each challenge as a unique problem that requires a creative solution. This is where artistry and surgery intersect.

 

Why Choose AGEI for your eyelid surgery?

Your eyes are one of the most delicate structures in your body. That’s why, when you’re looking for a Los Angeles area surgeon to correct the appearance or function of your eyelids and the structures surrounding your eyes, you want to seek out an oculoplastic surgeon.

 

As a trained ophthalmologist with a sub-specialty in oculoplastic surgery, Dr. Rafi Israel is able to thoroughly examine your eyes, understand any underlying eye disease, and identify potential problems that might impact the surgical plan -- things that even a board-certified facial plastic surgeon is not trained to do.

 

Dr. Israel has decades of experience in treating functional eye problems affecting patients’ vision and eye health. He has performed thousands of cosmetic procedures, including revisions of surgeries performed elsewhere with unsatisfactory outcomes.

 

Among the conditions that AGEI treats are excess eyelid skin or fat, drooping eyelids, wrinkles around the eyes, eyelid reconstruction after tumor removal or eye injuries, excessive tearing, revising prior unsatisfactory eyelid surgeries, and abnormally turned in (entropion) or turned out (ectropion) lid margins.

 

If you would like to schedule a consultation in our Beverly Hills office to discuss your concerns about the appearance or function of your eyelids and to learn what treatments might be right for you, please call 866-945-2745 or click here to request an appointment online.

 

At AGEI we take our patients’ safety seriously. That’s why our facility’s Covid-19 patient safety procedures exceed all CDC recommendations.

 

 

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