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Tearing
 


Tears are produced by the lacrimal glands; each blink lubricates the  globe and moves the tears medially towards the nasolacrimal ducts (tear  ducts), which drain the tears into the nose. Tearing, also known as  epiphora, can be caused by a number of reasons. A patient with tearing  needs to have a comprehensive evaluation so the correct cause and  treatment plan can be determined. Here are some common reasons for  tearing.• Blepharitis:this is inflammation of the eyelids, and is probably  the most common cause of tearing. The oily layer of the tear film is  produced by the glands around the eyelid. This layer plays an important  role in preventing rapid evaporation of the tears. With inflammation,  these oil-producing glands can get clogged. As a result, the tear film  will lack this important component and thus evaporate rapidly, leading  to dry eye syndrome. The irritated, dry feeling sends signals to the  brain to produce more tears, thus the reason for excessive tearing in  these patients. The treatment involves treating the underlying  blepharitis and use of artificial tears.• Eyelid malposition: As explained  above, the blink dynamic is very important in the proper movement of  tears across the eye surface and its drainage into the tear ducts. If  the eyelids are malpositioned for whatever reason the patient will have  excessive tearing. Previous trauma, tumors, congenital defects,  ectropion and entropion are a few causes of eyelid malposition. The  patient needs to be evaluated, and reconstructive surgery should be  undertaken to correct the underlying cause.• Nasolacrimal duct obstruction: Also  known as the tear duct the nasolacrimal duct is responsible for  draining the tears into the nose. This is why a person who is crying  will also have a runny nose. If this passage is blocked, the patient  will complain of excessive tearing. There are two types of nasolacrimal  duct obstruction, congenital and acquired.• Congenital Nasolacrimal Duct (NLD) Obstruction  is a fairly common condition in children whom there is failure of the  nasolacrimal duct to open into the nose. If this is the case, tears,  mucous, and bacteria cannot be properly cleared from the eye, and as a  result the child will have constant tearing. About 80% of congenital  NLD obstructions will resolve spontaneously by one year of age. Thus if  a child is younger then one, the parents are instructed to massage the  nasolacrimal sac (the area near the nose on the lower eyelid) 4 to 5  times a day. If the child has persistent tearing after 12 months of  age, a nasolacrimal probing procedure is performed. This procedure is  done under general anesthesia. The procedure usually takes just a few  minutes, and the infant or child will likely be entirely pain-free  afterwards. NLD probing is about 90 to 95% effective and is an  extraordinarily safe procedure. For those few infants in which NLD  probing fails, a second probing may be attempted or silicone tubes may  be placed in the NLD until an open passageway is secured about three to  six months after placement . • Acquired Nasolacrimal Duct Obstruction usually  occurs in middle or late adulthood. These patients typically complain  of persistent tearing and the tears run out of one eye. This condition  is diagnosed by the clinician, who will check with a dye disappearance  test or NLD irrigation. If the diagnosis of acquired NLD obstruction is  confirmed, the patient may be offered a curative procedure known as  dacryocystorhinostomy (DCR). The DCR Procedure:   Since the nasolacrimal ducts are blocked, the goal of this procedure is  to create a new tear drainage path into the nose. There are two ways to  perform this procedure. One is the external DCR, which involves making  an incision outside the nose. This procedure has a better success rate  then the endoscopic DCR, which has no external incisions. Once the new  pathway is created, a tiny plastic stent is placed for 3 to 6 months to  ensure proper healing of the new drainage system.
 
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