The Lacrimal System
The lacrimal (tear) system is comprised of tear producing glands and a system to drain these tears. Problems with either system can produce problems for the eyes and vision. In order for the eye to remain healthy, it must remain moist. Each time you blink, the eyelid spreads the tears over the surface of the eye and pumps excess tears in a “pipe” or duct that drains the tears into your nose. That is why your nose runs when your cry. Oculoplastic surgeons are uniquely skilled and trained in the diagnosis and treatment of lacrimal system problems.
If the lacrimal gland fails to produce enough tears to properly wet the eye, the surface of the eye begins to dry out. An eye that is too dry typically burns, stings and feels as if there is sand in it. New and exciting treatments for dry eyes continue to develop. Doctor Cowen and his team try to stay abreast of these new treatment options.
Teary or Wet Eyes:
If the lacrimal gland is producing tears properly and the “pipe” that drains the tears from the eye into the nose becomes non-functioning, the tears will back up and spill over the eyelid and run down the face. If one has a blocked tear duct, not only will tears spill over the eyelids and run down the face, but the stagnant tears within the system can become infected causing discharge to collect between the eyelids. Patients are at a higher risk for eye infection after cataract and other eye surgeries.
Blocked Tear Ducts in Infants (Congenital Lacrimal Obstruction) and Adults (Lacrimal Duct Obstruction): Children are frequently born with a congenital obstruction within the tear drainage system in either one or both eyes. In most infants, the obstruction is caused by a membrane at the base of the tear duct just before the duct enters the nose. Such obstructions may resolve on their own within the first few months of life. If not, Dr. Cowen can eliminate this problem with refined surgical techniques that are brief and painless. Sometimes it is necessary to surgically create a new “tear pipe” behind the inner corner of the eyelids to drain the tears into your nose. This is an outpatient surgery and highly successful in the trained hands of a lacrimal surgeon.
When a lower eyelid turns outward and no longer touches the eye it cannot properly spread the tear film across it. The exposed inner lining of the eyelid becomes dry and inflamed causing chronic irritation to the eyelid and the eye. This can result in excessive tearing, crusting of the eyelids and mucous discharge, infection irritation of the cornea (front of the eye) and impaired vision. An ectropion is usually due to relaxation of the tissues of the eyelid as the result of aging. Thus it is most often seen in elderly people who develop stretching of the structures supporting the lower eyelid. It can also arise as the result of an undetected skin cancer pulling the eyelid downward, trauma and contraction of scar tissue (from wounds, burns or surgery) involving the skin around the lower eyelid.