Summary
A watering eye is one of the commonest reasons for referral to an oculoplastic surgeon, and one of the most rewarding to treat well. The key is accurate diagnosis before any procedure, because watering can come from a dry eye that reflexively over-produces tears, an eyelid that is no longer holding the tears against the surface, or a true blockage in the tear-drainage system.
Who is this for?
Patients I commonly see in my lacrimal clinic:
- chronic, daily watering (‘I always need a tissue’),
- watering with a sticky discharge or recurrent infections,
- watering after sinus or nasal surgery,
- watering on one side after eyelid trauma or skin cancer surgery,
- children with persistent watering since birth (referred via paediatric pathways).
I also use the TEARS score, a patient-reported outcome measure I co-developed with Mr Raman Malhotra, to track watering severity before and after treatment.
Is this funded on the NHS?
Tear duct surgery is the quiet corner of eyelid funding, and it needs handling carefully. Thirty of the thirty-six boards in England have no published policy on epiphora or tear duct surgery that I have been able to locate, and Hampshire is one of them. That absence is not a refusal. It is far more likely to mean the surgery is simply commissioned as ordinary ophthalmology, and you should be wary of anyone who reads a blank as a no. Where boards have recently written a policy, the shape of it is consistent: they want conservative measures to have been tried, and then either a blocked duct that is causing repeated infection or a distended tear sac, or daily watering that is affecting vision and quality of life. Children are usually exempted from the restrictions altogether. An acutely infected tear sac is an urgent problem in its own right and is not a funding question at all. What is and is not published on tear duct surgery is set out board by board, absences included.
What the assessment involves
A typical lacrimal assessment includes:
- a focused history and use of the TEARS score,
- examination of the eyelids, lashes and tear film,
- assessment of eyelid position and tone,
- syringing and probing of the tear ducts under topical anaesthetic,
- where indicated, dacryocystography or MR dacryocystography for detailed imaging.
By the end of the visit you will have a clear explanation of what is causing the watering and what your options are.
After the assessment
Depending on the diagnosis, treatment may include:
- a course of lubricants for dry-eye-related reflex tearing,
- a punctoplasty for narrow puncta,
- an endoscopic DCR or external DCR for nasolacrimal duct blockage,
- canalicular surgery or Lester Jones tubes for upper-system blockage,
- treatment of an underlying eyelid malposition.
Risks and alternatives
The assessment itself is low-risk. The main ‘risk’ is being undertreated for many years because the cause was never properly identified, which is why a careful, structured assessment matters.