Dr. Lauren Demaria Mileo, MD

Normally, the tears that constantly bathe the eyes are drained through two tiny holes in the eyelid, where they run through a duct into the nose. This tear duct can become clogged or blocked, causing tears to back up and leading to watery eyes. Common causes of tear duct blockages include trauma, a facial tumor, and inflammation due to certain medical conditions, but usually the cause is not known. Clogged tear ducts are especially common in young children. If the blockage is permanent and located lower in the duct, near the nose, DCR may be performed to create a bypass and allow tears to drain freely again.

During DCR surgery, a small hole is made in the bone and tissue between the upper part of the tear duct and the nasal passage. Usually, a tiny plastic tube called a stent is placed into the opening to protect it and keep it open during healing. DCR may be performed through an open incision on the upper cheek near the nose, or it may be performed endoscopically using tiny instruments that are passed through the nostril. Open surgery is more common, and has a slightly higher success rate, although endoscopic surgery causes less pain and bleeding during recovery. DCR is able to correct the blockage and watering eyes in nearly 95% of cases.

The surgery itself takes only about half an hour. It is usually done under general anesthesia, which may require a short hospital stay while patients recover. Small amounts of bleeding from the nose are not uncommon for the first 24 hours, and bruising and swelling are expected for the first two weeks. Don't be alarmed if the eye continues to water at first. Swelling in the area due to surgery can cause the eye to water, but this should go away as patients heal.

The choice of reconstruction technique depends on the size and severity of the defect. If tissue loss is small to moderate, the wound may simply be sutured close. For larger defects, however, tissue from other parts of the body may be needed. Tissue may be taken (or harvested) from the ear, scalp, abdomen, roof of the mouth, inside of the check, or the eyelid itself.

The Hughes procedure and the Cutler-Beard procedure are reconstruction techniques that use eyelid tissue. In the Hughes procedure, a piece of neighboring tarsoconjunctival tissue is cut, slid onto the wound, and then sutured together. The tarsoconjunctiva is made up of the connective tissue that provides support to the eyelid, called tarsus, and the membrane covering the white of the eyes, called conjunctiva. This technique is suited for defects that are located on the sides of the eyelid. The Cutler-Beard procedure requires a thicker segment of tarsoconjunctival tissue and is used to repair defects in the center of the eyelid.

Eyelid reconstruction is commonly done at an outpatient facility. There will be bruising and swelling for about four to ten days following surgery. Patients should keep their heads elevated, use cold compress, and apply antibiotic cream on their eyelids for the first few days. Strenuous activities must be avoided for four weeks, but patients may be able to return to work after about a week.

Hashimoto's is the leading cause of hypothyroidism, which is when the thyroid does not produce enough hormones to stimulate adequate metabolism. The condition is diagnosed by blood tests that measure TSH (thyroid stimulating hormone) and detect Hashimoto's antibodies. Symptoms of hypothyroidism include sluggish metabolism, inflammation, fatigue, weight gain, brittle hair, dry skin, and sensitivity to cold. To supplement impaired thyroid function, patients with Hashimoto's are typically prescribed synthetic thyroid hormone pills. Such patients may need to consume synthetic thyroids for the rest of their lives. Other treatments may include dietary changes, such as the avoidance of certain foods and medication to reduce inflammation. Frequent blood tests can inform patients if their TSH levels are within a normal range.

Grave's disease is most frequently the cause of hyperthyroidism, which is when the thyroid produces too many hormones, overstimulating one's metabolism. The condition is also diagnosed by blood tests that measure TSH and detect Grave's antibodies. Elevated heart rate, high blood pressure, sweating, bulging eyes, and weight loss are common symptoms of hyperthyroidism. Treatments for hyperthyroidism include oral radioactive iodine, which slowly shrinks the thyroid, slowing the production of excess thyroid hormone. Other anti-thyroid medications such as methimazole (Tapazole) also reduce the production of thyroid hormones. Blood pressure medications known as beta blockers can ease the increased heart rate caused by hyperthyroidism. If treatments are unsuccessful, patients may be prescribed a thyroidectomy, or surgery to remove part or all of the thyroid. Some patients with hyperthyroidism may require ophthalmological (eye medicine) treatments such as eye drops, prednisone, and surgery to reduce eye swelling and bulging.

Untreated thyroid disorders frequently lead to goiters or thyroid nodules. A thyroid goiter is a large lump that can be felt near the base of the neck and is made of swollen thyroid tissue or nodules (excess cell growth). Nodules and goiters are diagnosed by CT scan or ultrasound. Obstructive goiters can cause pain, coughing, and abnormal breathing. The most common cause of goiters is hyperthyroidism (overactive thyroid). However, Hashimoto's is also known to cause goiters or nodules. Goiters develop from continued damage from antibodies to the thyroid over time. At times, a goiter can result from a cancerous thyroid tumor. Most goiters and nodules are themselves benign.

The exact causes of thyroid cancer are unknown. People who develop thyroid cancer may or may not have another thyroid problem such as Hashimoto's or Grave's disease. Symptoms of thyroid cancer include a nodule that can be felt on the neck, hoarseness, difficulty swallowing, swelling in the neck, and neck and throat pain. CT and MRI scans are used to diagnose thyroid cancer. There are four types of thyroid cancer which vary in intensity. Thyroidectomy (thyroid removal surgery) is usually prescribed to treat thyroid cancer.

Thyroid problems are often long-term conditions that require some form of treatment. With regular monitoring and medication, many people with thyroid problems are able to lead active and fulfilling lives.