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 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.