Indonesia Headlines

Many thousands of Britons suffer from permanently watery eyes, making everyday tasks such as driving, watching TV or even socialising impossible. 


Wayne Farrell, 56, a local government officer from South Yorkshire, underwent a new procedure for this debilitating problem. Here, he talks to THEA JOURDAN. 

A couple of years ago, my eyes started to water a lot, and before long I had constantly streaming tears. I'm a keen runner and at first thought it might have something to do with running on cold windy days, because that's when it seemed to be worse. I also put it down to age.

Although I wasn't in pain, it was really annoying because I was having to dab my eyes all the time. I have to meet lots of customers for my job and I always looked as if I was crying.

I got so fed up with people staring that I stopped going out with friends and colleagues. I put up with it for a year without getting any help, but after my daughter Charlotte's wedding last summer I knew I had to get it sorted.

It was a wonderful day - but full of tears for the wrong reasons. As I walked her down the aisle, I could hardly see. The guests must have thought I was really going over the top and I couldn't even read my speech through the tears. It was so embarrassing.

My wife Janette is a nurse and she thought I might have blocked tear ducts. My GP agreed and referred me to a nurse at Rotherham General Hospital.

She explained we all constantly make tears to keep our eyes moist. Normally they drain away through tiny holes (tear ducts) at the side of the eye and down your nose, but because my right one was totally blocked and my left one partially blocked, the tears were running down my cheeks.

I told the nurse that I'd never had an eye infection, but she said the holes can become permanently blocked even from a cold.

I was referred to Mr Harkness, a specialist ear, nose and throat surgeon, and saw him eight weeks later.

He told me I'd need surgery to unblock the ducts, which they normally do by making two-inch-long cuts at the top of the nose under general anaesthetic.

Then he told me about a new type of operation where they work inside your nose, so there are no scars. He said it would be less painful and could be done under local anaesthetic, so I could go home the same day.

First he'd make a new drainage channel for my tears which he would keep open with tiny plastic tubes in the corner of my eye. They could then be removed after three months, once the hole was open permanently.

On the day of the op, a couple of weeks later, I opted for a general anaesthetic because I'm quite squeamish.

When I woke up, I wasn't in pain, although the inside of my nose bled for a few hours. I went home later that day and took two weeks off work.

You could see the clear plastic tubes if you looked really closely, but nothing else - the ends of them were hanging down inside my nose. The only problem with that is that they made me sneeze all the time.

When I went back to have the tubes removed, Mr Harkness simply snipped the loop at the corner of my eyes and pulled them out through my nose. It did feel strange, but what was so amazing was that there were fewer tears, and over the next few weeks they stopped completely.

Now I'm fine and back to running 5km a day. Best of all, when my daughter Genaya decides to get married, I'll know I'll be at her side with a tear in my eye, but not splashing down my cheeks.

Mr Paul Harkness is a consultant ENT surgeon at Rotherham General Hospital Foundation Trust. 
 

He says... Crying all the time is such an annoying and debilitating problem - I see lots of patients who are at their wits' end. It's usually because the tear ducts become blocked. This can be caused by several things, but it's generally down to repeated scarring caused by colds and flu.

When Mr Farrell came to my watery eye clinic, I first took a history to ensure he wasn't suffering from an undiagnosed allergy. I then confirmed the ducts were blocked, by squirting sterilised water into them.

This did not drain away through into the nose, to be swallowed, as it should, but down the cheeks.

The only option for blocked ducts is surgery. We make a new channel for the tears in the corner of the eye, then prop it open with a tiny plastic tube called a stent. This stays in place for three months until we're certain the hole won't close up again.

In the past, this was done by open surgery, making one-inch incisions on each side of the nose near the corner of the eye, and chipping through the nasal bone from the outside until the blocked ducts were reached.

This was effective but time-consuming, taking over an hour to do. Patients were also left with two noticeable scars in the middle of their face.

I suggested Mr Farrell had a new procedure called an endoscopic DCR. Basically, we can now perform the surgery from the inside of the nose, meaning there are no scars. It is just as effective, but means less pain and patients need less time to recover.

Although Mr Farrell opted for a general anaesthetic, half of patients choose a local because it means you can go back to work the next day.

First I inserted an endoscope - a camera on a rigid tube - into Mr Farrell's left nostril. This lit up the area and relayed images to a screen above his head.

Then, using a tiny blade, I cut away a small flap of mucous membrane- - the tissue that lines the inside of the nose. Under the flap is bone, which protects the tear duct that runs inside.

I nibbled away with a special bone-cutting device until I had made a window and could see the tear duct beneath. This is purple and several millimetres wide - it looks a bit like an earthworm.

I then created a new drainage channel by putting the stent into the tiny drainage hole in the lower lid and pushing it down into the nose through the tissue.

The other end goes into the hole in the top lid, so the stent is looped around the corner of the eye, with both ends hanging down into the nose.

The purpose of the stent is to open up the new duct completely for three months until I can be sure it will remain open.

From now on, tears will drain through the hole in the duct and the nasal bone, directly into the nose instead of down the face.

Then I replaced the mucous membrane over the wound site, leaving a small gap for the stent. It sticks in place without the need for any stitches.

I then did the other nostril - each side takes 15-20 minutes.

Like virtually all patients, Mr Farrell was well enough to go home the same day, and he recovered well. His eyes did keep watering at first, but that is normal until the stents are removed.

Removal is done using local anaesthetic eye drops. I simply snipped the silicon visible in the corner of both his eyes and pulled the stents out of his nose.

I have performed more than 400 of these procedures and the success rate is around 80 per cent. For the small minority who need a further operation, half are happy second time around.