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Tearing System

Tearing

The tear film on the surface of the eye is a critical component of maintaining vision. Tears nourish and lubricate the surface of the eye as well as wash away debris. A smooth, balanced tear film (consisting of water, oil and mucus) also allows light to enter the eye in an optimal fashion. If there is a disturbance of the tear film, patients will often experience tearing, burning, irritation and most importantly blurred vision. Patients who experience tearing either have a problem with tear production or tear drainage.

Increased Tear Production and Dry Eyes

The eye has two sets of structures that produce tears. Smaller tear glands help maintain a baseline level of moisture on the surface of the eye. Unfortunately, inflammatory conditions like rheumatoid arthritis, Sjogrens disease as well as aging and menopause lead to decreased tear production. As tear production diminishes, the surface of the eye starts to dry out. Further, inflammation of the oil glands along the edge of the eyelid, common in patients with roseacea, also causes early breakdown and evaporation of the tear film. The brain senses the eye is both dry and irritated and in turn signals the main tear gland to flush the eye. As a result, the dry eye paradoxically tears and becomes watery. Patients with dry eyes note intermittent tearing of the eyes during activities like reading, driving, watching TV, using a computer or going outside on a windy day.These all cause the eye to dry out because the eye blinks less during these activities. The treatment for dry eyes includes 1) replacing tears with artificial lubricants which can be bought over the counter, 2) medications like Restasis that decrease inflammation in tear glands and encourages natural tear production to resume and finally 3) plugging of the tear drain.

Other causes of increased tear production exist like allergies, infections and eyelashes poking the eye. These conditions can often be found during examination.

Blocked Tear Drain

While most patients with tearing have some form of dry eye, another important cause of tearing is a blocked tear drain. The tear drain has an entrance in the inside corner of both the upper and lower lids. They join together to form the tear drain duct that runs from the inside corner of the eye into the nose. The presence of the drain explains why we taste our tears or eye drops. An obstruction of the drain can be congenital or acquired later in life.

Congenital tear drain obstructions occur in 6% of newborns and fortunately 90% of these resolve on their own in the first year of life. Other conditions may cause tearing in newborns, thus all babies with tearing should be examined. During the first year of life massage of the tear drain along with intermittent use of topical antibiotics (if there is discharge) is the best course of action. After age one, surgery that involves probing the tear drain under anesthesia, is utilized to open the drain. This surgery is over 90% successful. In the few cases that fail to respond, a second surgery can be performed with the insertion of a temporary stent or dilation of the system using a special balloon probe. Rarely is bypass surgery of the tear drain needed in children, but it is highly effective.

Acquired tear drain obstructions most commonly occur in adults, especially after the age of 50. Still younger individuals may develop scarring from a bad infection or other problem in the eye. Patients with a blocked tear duct almost always complain of constant tearing from the eye that runs down their face. This diagnosis is made in the office after a thorough exam and several office tests. When an obstruction is present in the adult patient probing, balloon dilation and stenting can sometimes be used however most patients require tear drain bypass surgery. This is done under anesthesia in the operating room. Two approaches can be used: either an external incision on the side of the nose can be used to open the system form the outside to the inside of the nose or more recently, working form the inside the nose, the system can be opened from the inside to the out thus avoid an external incision. Either way, the surgery is 80-90% successful.

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Oculo-Facial Plastic Surgery Information

Oculo-Facial Plastic Surgery
Botox®
Fillers (Restylane™, Radiesse™)
Eyelid surgery
Reconstructive Ophthalmic Plastic Surgery
Cosmetic Facial Plastic Surgery
Orbital Disease & Trauma
Skin Rejuvenation
Tearing
Patient Testimonials
Pre & Post Op Instructions
Before & After Photo Galleries