Barton L. Halpern, M.D., F.A.C.S.
Theodore D. Jones, M.D.
Catherine H. Bene, M.D.
Leonard B. Nelson, M.D.
Epiphoria in Adults
Epiphora, or uncontrolled tearing, is frequently caused by a blockage of the tear drainage system. Four tiny tear holes called puncta (singular: punctum) drain tears via the nasolacrimal ducts from the eyelids into pouches at either side of the nose, the lacrimal sacs. From here, tears drain into the nose via natural tubes called the lacrimal canals, and the tears then go to the throat. Symptoms of nasolacrimal obstruction include tearing, matting of the eyelashes, or mucous or pus-like discharge from the puncta. In some cases, this elevates the risk of infection to the nasolacrimal system, which can worsen the condition. Nasolacrimal duct obstruction can be alleviated by a new procedure called Balloon DCR (Dacryo-Cysto-Rhinostomy), during which a balloon-tipped probe is passed into the tear drainage system and then the nose, creating a new passage as it is inflated. Special artificial tubing is left in place temporarily to keep this new passage from scarring shut. Antibiotics and anti-inflammatory eye drops also keep infection and scarring to a minimum. Notably, no skin incision is required with this procedure and patients heal quickly and sustain minimal bleeding. This procedure can even be performed under local anesthesia in the ophthalmologist's office.
Epiphoria in Children
Persistent tearing, or epiphora, is a common problem in infants, affecting approximately 5% of newborns. It is caused by a congenital blockage of the portion of the tear drainage system called the nasolacrimal duct, a conduit leading tears from the punctum (the open end of the tear drainage system in the eyelid) to the lacrimal sac (a pouch in the side of the nose, from whence tears are directed down into the nose). Fortunately, 70-90% of children born with this problem do not need surgery, but instead are cured within the first year of age by massage over the lacrimal sac and antibiotic eyedrops. If the tearing does not resolve by 10-11 months, a procedure can be performed under general anesthesia during which a probe is passed through the tear drainage system. The probe gently punctures the membrane in the nose that causes the blockage at the end of the tear drainage system and cures the problem in over 90% of cases if performed before a patient reaches 13 months of age. Notably, no incision is required in this procedure. If probing is not successful, or if tearing is present in older children, a newly available procedure called a Balloon Dacryoplasty can be used. Here, a balloon-tipped probe is passed into the tear drainage system, inflated to widen the channels of the system, and then removed. As with probing, no incision is required and antibiotics and anti-inflammatory drops are used to speed healing. If a child is known to have tearing, a visit with a Pediatric Ophthalmology specialist is imperative, and should be scheduled prior to a child reaching one year of age if possible; after one year of age, more complicated procedures are often necessary.
