Disease of lacrimal gland

The lacrimal drainage system consists of the following structures:

• The puncta
• The canaliculi
• The lacrimal sac
• The nasolacrimal duct

What causes watering of eyes?

• Hypersecretion – secondary to anterior segment diseases such as dry eye or inflammation.
• Defective drainage due to a compromised lacrimal drainage system.

This may be caused by the below-mentioned factors:

1. Malposition of lacrimal puncta.
2. Obstruction at any point along with the drainage system.
3. Lacrimal pump failure.

Evaluation of the patient

A detailed history should be taken. The patient usually complains of watering, ocular discomfort, redness and discharge from the eyes.

Drainage failure of the lacrimal system of the eyes is often exacerbated by the ocular environment, especially when it’s cold and a windy atmosphere.

The lacrimal drainage system of the eyes is evaluated by a series of tests such as,

1. Fluorescein disappearance test
2. Lacrimal irrigation
3. Jones dye testing
4. Contrast dacryocystography
5. Nuclear lacrimal scintigraphy
6. Internal nasal examination by an Otolaryngologist, if needed.

Based on the series of investigations, the obstruction in the lacrimal drainage system can be classified as –

Acquired obstruction 

Acquired obstruction is when the cause is due to blockage caused by punctal stenosis, conjunctivochalasis, canalicular obstruction, nasolacrimal duct obstruction and dacryolithiasis.

Congenital obstruction

The nasolacrimal duct obstruction is usually treated by surgical intervention. The procedure is termed dacryocystorhinostomy.

Congenital obstruction is when there is incomplete canalisation at the distal end of the duct, creating an imperforate membrane.

Massage of the lacrimal sac is advised for the initial 12 to 18 months. If the complaints persist, the patient is subjected to probing to disrupt the obstructive membrane causing an obstruction.

The newborn often presents with symptoms such as constant watering, matting of eyelashes and gentle pressure upon the lacrimal sac resulting in reflux of mucopurulent discharge.

Dacryocystitis 

Dacryocystitis is a painful condition when the patient presents with severe pain, swelling and watering of the eye due to an infection of the obstructed nasolacrimal system.

The patient is treated with oral and topical antibiotics and is planned for surgery at a later date.

CONCLUSION

As the advancement in science progresses, treating such issues has become easier. People are more aware of their conditions and reach out to the concerned specialist. So contact your ophthalmologist if you persist in having redness or increased watering of your eyes.