Epiphora (eye watering) & Lacrimal surgery

Epiphora — persistent or excessive watering of the eyes — is a common but often underestimated condition. While occasional watering can be normal, chronic epiphora usually indicates a problem with the tear drainage system (lacrimal system) rather than excess tear production. Left untreated, it can cause constant discomfort, blurred vision, recurrent infections, and significant impact on daily life.

At Hampshire ENT Clinics, lacrimal (tear duct) surgery is led by Mr Steve Hayes, Consultant ENT Surgeon and Rhinologist, who runs the largest endoscopic lacrimal surgery service on the South Coast and is recognised as a regional and national specialist.

Specialist Expertise in Endoscopic Lacrimal Surgery

Mr Hayes specialises in endoscopic lacrimal surgery, a minimally invasive technique performed through the nose without any external skin incision. This approach allows direct access to the tear drainage system while preserving normal anatomy and avoiding facial scarring.

He has extensive experience in managing the full spectrum of lacrimal conditions, including:

  • Primary acquired nasolacrimal duct obstruction

  • Chronic or recurrent watery eyes (epiphora)

  • Recurrent dacryocystitis (tear sac infections)

  • Canalicular and distal tear duct obstruction

  • Lacrimal obstruction associated with sinus disease or nasal anatomy

  • Failed previous lacrimal surgery

Mr Hayes is particularly recognised as a revision lacrimal surgery expert, frequently treating patients whose previous procedures elsewhere have been unsuccessful.

Largest Endoscopic Lacrimal Practice on the South Coast

The lacrimal service at Hampshire ENT Clinics represents the highest-volume endoscopic lacrimal practice on the South Coast, allowing outcomes that are strongly linked to experience, precision, and case complexity.

This high-volume practice supports:

  • Excellent success rates

  • Safe management of complex and revision cases

  • Use of advanced technology and refined techniques

  • Seamless integration of nasal and sinus assessment

Mr Hayes routinely performs lacrimal surgery using state-of-the-art endoscopic equipment, image-guided techniques where appropriate, and modern stenting strategies tailored to each patient’s anatomy and pathology.

Multidisciplinary Lacrimal Care

Effective lacrimal surgery often requires close collaboration between specialties. Mr Hayes works in established multidisciplinary partnership with consultant oculoplastic ophthalmologists, ensuring comprehensive assessment of both the eye and nasal aspects of tear drainage problems.

This collaborative approach is particularly important for:

  • Complex or high-grade obstructions

  • Patients with eyelid or canalicular disease

  • Revision surgery

  • Combined ophthalmic–ENT pathology

Patients benefit from a joined-up, specialist pathway rather than fragmented care.

Personalised Assessment and Honest Advice

Every patient undergoes a detailed consultation, including nasal endoscopy and careful assessment of the lacrimal drainage pathway. Not all watering requires surgery, and where conservative or alternative treatments are more appropriate, this is discussed openly.

When surgery is recommended, the focus is on:

  • Definitive symptom relief

  • Long-term patency of the tear drainage system

  • Minimal disruption and rapid recovery

  • Avoidance of unnecessary procedures

The aim is always a durable solution, even in challenging or previously treated cases.

  • Persistent watering is usually caused by poor tear drainage, not excessive tear production. Even when the eye feels comfortable, tears can overflow if the lacrimal drainage pathway is narrowed or blocked further downstream.

  • Features that suggest a drainage issue include:

    • Watering worse outdoors or in cold/windy conditions

    • Tears running down the cheek rather than mild eye irritation

    • Recurrent stickiness or infection at the inner corner of the eye

    • Symptoms affecting one eye more than the other

    Assessment often requires nasal examination as well as eye evaluation.

  • The lower end of the tear drainage system opens inside the nose. Many obstructions are related to nasal anatomy, inflammation, or scarring. An ENT-led endoscopic approach allows direct treatment of the obstruction from within the nose, often avoiding external incisions and addressing contributing nasal factors at the same time.

  • Endoscopic dacryocystorhinostomy (DCR) is performed through the nostril using telescopes:

    • No skin incision

    • No facial scar

    • Direct visualisation of the blockage

    • Ability to treat nasal contributors at the same sitting

    External DCR remains appropriate in selected cases, but many patients benefit from a modern endoscopic approach.

  • Common reasons include:

    • Inadequate opening size

    • Unrecognised nasal scarring or inflammation

    • Poor healing environment

    • Incomplete management of the lacrimal sac

    • Lack of ENT involvement when nasal factors are present

    Revision surgery requires careful identification of the original failure mechanism.

  • Yes. Revision lacrimal surgery is a major part of Mr Hayes’ practice. Even after failed external or endoscopic procedures, durable symptom improvement is often achievable with:

    • Detailed endoscopic assessment

    • Removal of scar tissue

    • Re-establishing a stable drainage pathway

    • Tailored stenting strategies

  • Not always. Stents are used selectively depending on:

    • Site of obstruction

    • Tissue quality

    • Revision status

    • Risk of restenosis

    The goal is long-term drainage, not routine hardware.

  • Yes. Nasal inflammation, septal deviation, turbinate enlargement, or sinus disease can contribute to tear duct obstruction. Treating these factors improves both surgical success and symptom relief.

  • Ongoing epiphora can lead to:

    • Recurrent infections (dacryocystitis)

    • Skin irritation

    • Blurred vision

    • Social and functional inconvenience

    Early assessment reduces the risk of chronic infection and complex disease.

  • Discomfort is usually mild. Most patients describe pressure rather than pain, and recovery is generally quicker than expected. Nasal congestion is common initially and settles over days to weeks.

  • Improvement is often noticed early, but final assessment is usually made over several weeks as swelling settles and healing completes. Revision cases may take longer to fully declare.

  • No lasting effects are expected. Temporary nasal congestion is common early on, but long-term nasal function is preserved.

  • Lacrimal surgery outcomes are strongly volume-dependent. High-volume practice allows:

    • Better recognition of anatomical variants

    • More refined technique

    • Greater success in revision cases

    • Fewer unnecessary procedures

    This is particularly important for patients who have already had unsuccessful treatment.

  • Yes. Mr Hayes works closely with consultant oculoplastic ophthalmologists to ensure the entire tear drainage system is assessed and treated appropriately.

  • No. You can self-refer directly for specialist lacrimal assessment.

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