Watery eye treatment

What is epiphora (watery eyes)?

Epiphora, more commonly known as watery eyes, is a common condition that occurs when your eyes are either producing too many tears or your tears aren’t draining away quickly enough. This causes a build-up of tear film on the surface of your eyes that can be irritating, blur your vision and make you look sad, or like you’re crying, even if you’re not.

What causes watery eyes?

• Dry eye syndrome: It may sound strange, but having a condition called dry eye syndrome can cause epiphora. This is because your dry eye symptoms will prompt your tear glands to make an excessive amount of tear film to overcompensate, causing flooding.
• External factors: Dry, dusty, smoky environments can cause excessive eye watering, as well as bright light, cold air and exposure to chemicals or bright sunlight (if you have photophobia).
• Inflammation and allergies: Inflammation and allergies are a common cause of eye watering, particularly hay fever caused by allergies to pollen, dust, mould or pet dander.
• Eye infections: Common eye infections such as conjunctivitis and blepharitis can cause excessive eye watering too.
• Physical damage to your eyes: Epiphora can also be caused by eye trauma, including a foreign object in your eye, ingrown eyelashes, chemical burns to the eye area, excessive eye rubbing or corneal abrasions, among other types of physical damage.
• Poor tear drainage: Sometimes it is possible for the drainage channels that usually remove excess fluid from your eyes to become blocked, triggering surplus tear film on the surface of your eyes.

How common are watery eyes in the UK?

Although there are currently no statistics specifically about the prevalence of watery eyes, they are thought to be extremely common in the UK. Dry eye disease (which is one of the most common causes of watery eyes) is estimated to affect around one third of the UK population.

What are the symptoms of watery eyes?

You could be forgiven for thinking that the only symptom of watery eyes is eyes that water excessively. However, this can also be accompanied by red eyes, blurred vision, light sensitivity, itching, mucus discharge and crusty eyelashes.

What are the treatment options for watery eyes?

Treatment for watery eyes really depends on the underlying cause of your condition and typically falls into three categories.

1. Home remedies/lifestyle changes

• Cleaning your eyes regularly using clean cotton pads for each eye
• Warm compresses
• Eyelid massage
• Avoiding smoking and potentially irritating environments.

2. Medications and eye drops

• Allergy medications, including eye drops and oral antihistamines
• Medicated eye drops, such as anti-inflammatory or antibiotic eye drops
• Artificial tears.

3. Surgical treatments

• Tear duct surgery (lacrimal surgery)
• Tear duct dilation
• Eyelid surgery (blepharoplasty)

What is tear duct surgery (lacrimal surgery)?

Lacrimal surgery is another name for tear duct surgery, a procedure designed to treat your eye’s drainage system with the aim of improving it so that it functions properly. There are several different types of lacrimal surgery, including:

Dacryocystorhinostomy (DCR)

This is the most common type of watery eye surgery for adults; it works by creating a new pathway between your tear sac and nasal cavity to bypass blocked tear ducts.

External DCR vs endonasal/endoscopic DCR - what's the difference?

These refer to two slightly different techniques for performing DCR. In an external DCR, the incision to create the pathway is made on the side of your nose near your inner eye. In endoscopic DCR, there is no external incision, and instead, the procedure is performed using an endoscope that is passed up into your nostril. The non-invasive approach typically has a lower rate of complications and a faster rate of recovery.

Lacrimal stenting

This is a procedure in which a small, flexible tube (called a stent) is placed into your tear drainage system to keep it open and allow tears to drain properly from your eye into your nose. It can be used as a standalone treatment for epiphora, or to support DCR surgery for watery eyes.

When should I consider surgery for watery eyes?

If you are experiencing excessively watery eyes and aren’t getting enough relief using more conventional treatments, you may want to consider surgery.

Who is suitable for watery eye treatment?

If you’re experiencing excessively watery eyes that are interfering with your day-to-day life, you are likely to be suitable for watery eye treatment. Most people are recommended to start with non-invasive treatment methods first, before progressing to more intense therapies if they are unsuccessful.

If you’ve tried more conservative treatments first and you aren’t getting enough relief from your symptoms, epiphora surgery could be a viable solution for you.

Who is not suitable for watery eye treatment?

You may not be a good candidate for watery eye treatment if you have:

• an active eye infection or eye disease, such as glaucoma
• severe scarring, such as from previous surgery
• a bleeding disorder.

You’ll need to have a comprehensive consultation to determine if you’re a suitable candidate for watery eye treatment.

How should I prepare for watery eye surgery?

You’ll be given some instructions to follow to help you prepare for watery eye surgery. These will help minimise your risk of complications, enhance your recovery and ensure you get the best possible outcome from your treatment.

These may include:

• stopping any regular medications as directed by your consultant
• using any pre-operative medications you are provided with as described, for example, if you’re having endoscopic DCR you may be given nasal decongestant spray to use ahead of your procedure
• limiting your alcohol intake, as this can make dry eye worse
• stopping smoking, as this is proven to increase your risk of complications and delay your recovery
• turning up on the day as instructed, with no makeup or cosmetics applied to your face.

Always follow the recommendations of your consultant ophthalmologist, and if you have any questions about your surgery, ask them ahead of the day.

What happens during watery eye surgery?

Exactly what will happen during your lacrimal surgery will depend on which technique is being used. You will either have a general anaesthetic (where you will be asleep for the duration of your procedure) or local anaesthetic combined with sedation, to ensure you are pain-free and comfortable throughout.

Your surgeon will be able to explain what to expect from your procedure, which they will do at your consultation.

Is watery eye surgery painful?

Epiphora surgery is carried out using either local or general anaesthetic, meaning that you shouldn’t be in any pain during the surgery itself. It’s normal to experience some discomfort in the days and sometimes weeks after your procedure, and you’ll be provided with pain relief or able to take over-the-counter pain medications to help with this.

How long does watery eye surgery take?

Watery eye surgery usually takes around 60 minutes for the actual procedure, with additional time needed for preparation/anaesthetic and recovery.

How long does it take to recover from watery eye surgery?

As with other surgeries, recovery from epiphora surgery takes place in several stages.

The first few days
Although you’ll be able to go home the same day as your watery eye surgery, you’ll need someone to drive you and stay with you, as the anaesthetic/sedation could leave you feeling tired and easily confused.

Your eyes could feel swollen, irritated, dry, itchy, watery, scratchy or otherwise uncomfortable, and you may find that you’re more sensitive to light than normal. You may also have some bruising. You may also find that your nose feels blocked, and you could have some blood-tinged discharge from your nostrils.

You’ll be advised to go home and rest, and to sleep with your head elevated to help control the post-operative swelling. You’ll also be given eye shields to wear to protect your eyes when you sleep, and a schedule of eye drops that it is essential that you follow.

Days three to seven
Your discomfort should improve significantly during the first week, and you should start to find that your bruising and swelling start to ease. Light activities like walking are fine, but you should avoid bending at the waist (as this increases pressure in your eyes), moderate to intense physical exercise and getting your eyes wet.

Weeks two to four
You should continue to see improvement in the appearance of swelling and bruising, and you probably don’t need to take pain medication anymore. You may be able to get back to activities like swimming and running, and if you have a manual job, go back to work.

Full recovery from watery eye surgery takes around six weeks. You should always follow the instructions of your consultant at every stage of the recovery process.

Will I still have watery eyes immediately after surgery?

Yes, it’s normal to still have excessively watery eyes straight after surgery, as temporary swelling and other trauma responses to the procedure trigger your eyes to produce more tear film than usual. Full improvement should be achieved around six weeks after surgery.

Is it normal to have a nosebleed after watery eye surgery?

Yes, it’s normal to see some blood in mucus from your nose, or to have minor nosebleeds. It is for this reason that you will be recommended to avoid blowing your nose or lifting anything heavy for at least two weeks after surgery.

When will the silicone tubes be removed after watery eye surgery?

If you’ve had silicone tubes (stents) placed during your surgery (to help keep the drainage channels open), these will need to be removed between six and 12 weeks later. It’s a quick, painless outpatient procedure that doesn’t require anaesthetic.

What are the possible risks and complications of watery eye surgery?

Although it is considered very safe and effective, there are a number of risks and complications associated with watery eye surgery. Your consultant will explain these to you in detail at your initial appointment or at your pre-surgery planning visit, so that you are fully informed.

Some of the most common include:

• internal or external scarring depending on technique used
• minor nosebleeds
• pain in and around your nose and eyes
• problems with the stent
• nasal blockage.

Other less common complications include:

• infection
• skin lump or swelling at the incision site
• no improvement in symptoms
• numbness around the incision site.

What is the success rate of watery eye surgery?

Success rates for watery eye surgery vary by technique, with external DCR boasting 80-95%.

What happens if watery eye surgery is unsuccessful?

If your watery eye surgery is unsuccessful, your surgeon may consider an alternative technique to improve drainage in your eye.

How much does watery eye treatment cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed all-inclusive price for the treatment following your initial consultation.