If tearing is present from birth, this condition is mostly due to obstruction of the tear duct, progresses with continuous watering and sometimes drooping, and resolves spontaneously in 80-90% of cases within months. In cases that do not improve by one year of age, we open the canal with short-term surgeries such as probing, tube insertion (intubation) at later ages, and at later ages, we perform adult type canal surgeries.
In adult patients, there are conditions that we must first rule out in patients presenting with excessive watering, especially age-related obstruction of the tear duct. With a detailed eye examination, we evaluate the eye surface that may cause excessive watering and look for dry eye and allergy conditions. With oculoplastic evaluation, we carefully evaluate lid edge diseases (meibomite, blepharitis), cases where the lid is excessively loose and sagging (ectropion), cases where the lid edge turns inwards (entropion) and eyelashes sink (trichiasis, distichiasis), and if we detect them, we correct them with medical treatment or surgery. . The next oculoplastic evaluation stage in patients with tearing where these conditions are not detected is the lavage process, which we perform by entering through the tear discharge holes (punctum) located on the inside of the lid. In this procedure performed in the office, we administer fluid through the punctums and check whether it passes from our nose to our nasal passages. If there is a blockage in the tear drainage system, the fluid will come back into the eye and we determine the level of blockage by looking at the level from which it comes back. There is usually a blockage in the extreme part of the duct, that is, the part that opens to the nose, this situation is called tear duct blockage. Although duct obstruction usually occurs in people over the age of 65, it can also be seen frequently in young patients. If we detect duct obstruction, the only treatment for this condition is to surgically create a new duct path. There are 3 methods for this. When the surgical incision is made through a cosmetic incision between the eyelid and cheek, there is no scar left. The surgery takes approximately 20-30 minutes under general anesthesia or sedative medication and the patient is discharged on the same day. A temporary tube can be installed in the duct system for safety purposes. This tube is simply removed in the office after 1 month. There is no pain in the postoperative period and you can return to work 1 day later if desired. Another method is a surgery method that we perform through the nose with endoscopes.
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