Casey Eye Institute at OHSU, Portland, Oregon

Where Healing, Teaching and Discovery Come Together

Tearing Management

The tear gland produces fluid constantly, keeping your eyes moist and comfortable. Normally, these tears drain away through tiny ducts located near the inside corners of the upper and lower eyelids. When the ducts are blocked, tears can overflow, sometimes associated with mucus discharge. You may also have blurred vision.  Rarely, a swollen, red, and very painful infection can occur in the skin and deeper tissues between the eye and the nose

Paradoxically, some patients with dry eye also have watery eyes. This happens when your body tries to soothe the dry eyes with extra tears which then overflow as the drainage system can't handle the increased reflex volume. Eyelashes that are turned inward and brush on the eye (trichiasis) can also cause the eyes to produce more tears than normal due to a reflex response to the irritation. Trichiasis can also occur if the eyelid margin turns in (entropion) with the same result.  This can be a dangerous situation for the eye do to the possibility of infection and scarring that could possibly result in reduction or even loss of vision.

Physicians in the Oculofacial Plastic and Reconstructive Surgery division treat patients with all types of tear and tear duct conditions.  We have a long history of doing so and an international reputation based on early, landmark work done in this area by Dr. Lester Jones and Dr. John Wobig here in Portland.  Both of these physicians were involved with OHSU for virtually their entire careers.

Conditions we often treat include:

  • Blocked external tear drain (punctal stenosis)
  • Blocked tear drain in eyelid (canalicular stenosis)
  • Blocked nasal tear drain (nasolacrimal duct obstruction)

Medical treatments can include artificial tears, artificial tear ointment, flax seed oil, omega 3 supplements, punctal plugs, and possible referral to a dry eye specialist.  When tearing is only occasional or improves with artificial tears, no further treatment is necessary.

Jones tube

Jones tube

A block in the tear drainage system may need to be treated with surgery. If necessary, doctors can create a new tear passageway in a surgery called a dacryocystorhinostomy, or DCR. A silicone stent is placed for 6 weeks and then removed.  Occasionally, this fails and a tiny tube made of Pyrex glass (Jones tube) is used to keep the passage open. Procedures to open the tear ducts have a greater than 90 percent success rate. Our doctors, Roger Dailey, M.D., F.A.C.S., John Ng, M.D., F.A.C.S., and Eric Steele, M.D., are experts in diagnosing and treating problems with the tear drainage system.

If you have concerns about abnormal tearing, please contact our office at 503 494-3020.

Lester T. Jones Chair of Oculofacial Plastic Surgery

Dr Dailey

Casey Eye Institute's Oculofacial Plastic Surgery Division's Lester T. Jones Endowed Chair extends the beliefs and interests of  Dr. Jones,who was arguably the best known lacrimal surgeon of modern times. He was committed to perpetuating the "whole physician" - a dedicated professional whose "primary concern focused on the patient, one who conducted research to create better diagnostic and treatment methods, and then shared the fruits of that research through publications as well as a wide variety of educational forums."

The fund supports clinical care and research to correct a variety of facial, orbital and lacrimal problems.

Today Dr. Dailey, the second recipient of the Lester Jones Chair, carries on Dr. Jones' work in patient care, teaching and research. He and his colleagues in the Oculofacial Plastic Surgery clinic at Casey are advancing our understanding of the anatomy and function of many facial structures, developing new surgical techniques, and caring for patients with the most advanced procedures and technology possible.  In conjunction with the original designer and manufacturer of the Jones tube, Gunther Weiss, Dr. Dailey introduced the "Frosted" Jones tube for clinical use in tear drainage surgery in 2003.  This tube is rapidly gaining acceptance worldwide as a primary or secondary option for patients with certain tear drainage disorders.