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Determine if excess tearing is from increased lacrimation, decreased drainage
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WAILEA, Hawaii — The first step in treating a patient with excess tearing is to determine if it is being caused by excess tearing or decreased drainage, according to a speaker here.
"When a patient presents with excess tearing, determine whether it is due to tear production or an increase in tears exiting the eye,” George B. Bartley, MD, said at Hawaiian Eye 2018.
Increased lacrimation may stem from entropion, trichiasis, exposure, foreign bodies, lid margin disease, tear deficiency/instability or trigeminal nerve stimulation, he said.
The underlying disorder must be corrected.
Decreased drainage could also be the culprit, Bartley said. In that case, poor lacrimal pump function, ectropion, punctal stenosis, canalicular disease, high obstruction or low obstruction may be at fault.
The various treatments include lid tightening procedure, ectropion repair, punctoplasty/ampullotomy, silicone lacrimal intubation, dacryocystorhinostomy (DCR), and conjunctivodacryocystorhinostomy with Jones tube, Bartley said.
Osteotomy size is often the main determinant of success in DCR.
“Almost every time a patient is presented to me with a failed DCR it’s because the original bone opening was too small. Don’t be afraid to make a big hole,” he said.
During DCR, finding an ethmoid air cell is possible, he added. “Don’t be afraid, you’re in the right spot,” Bartley said. – by Abigail Sutton
Reference:
Bartley GB. The crying game: Diagnosis and management of the tearing patient. Presented at: Hawaiian Eye; Jan. 13-19, 2018; Wailea, Hawaii.
Disclosure: Bartley reports no relevant financial disclosures.