Epiphora — more commonly referred to as watery eyes — is when you have excessive tear production. An overflow of tears due to excessive secretion of the lacrimal glands or obstruction of the lacrimal ducts.
Excessive tears are also known as Epiphora
Such as it is an overflow of tears onto the face, other than caused by normal crying. Epiphora happens when tear film and ocular surface problems rather than by anatomical obstruction of lacrimal drainage.
Generally, it usually happens if your tears don’t drain away properly or the production of tears is excessive.
Generally, these problems can occur as a result of conditions such as conjunctivitis (eye inflammation), problems with your eyelids, an eye injury, a blocked tear duct, or something irritating your eye, such as car fumes.
How tears work
Tears keep the eyes moist by the eye duct (lacrimal glands) constantly producing tears. The location of the eye duct underneath your upper eyelids.
When we blink, tears spread over the front of our eyes. The tears then pass into tiny channels known as canaliculi, before draining into a tear “sac” and flowing down the tear duct into your nose.
Generally, watering eyes are the result of problems with this process.
When to see your doctor when you have excessive tears production
For the most part, you should see your doctor if you have persistent watering eyes, or any lumps or swelling around your eyes.
Excessive tears production can happen at any age
You can get watering eyes at any age but it is most common in young babies (0-12 months) and people over the age of 60. It can affect one or both eyes and can cause blurred vision, sore eyelids, and sticky eyes.
How to treat excessive tears production
In particular, you should make an appointment to see a doctor if you are concerned by persistently watering your eyes.
Treatment of watery eyes is not always necessary. Generally, treatment will depend on how severe the problem is and what is causing it.
In the meantime, if watering eyes aren’t interfering with your life, you may choose not to have treatment.
In some cases where irritation is causing the eye to water, treatment involves removing the source of irritation. As an example, if an eyelash is growing into your eye removal of it can help.
Such as blockage in the duct causing excessive tears, need surgery to clear the blockage, or create an alternative way for tears to drain away.
Causes of excessive tears production
Similarly watering eyes usually occur if you have excessive tears production and they cannot drain away properly.
Excessive tears caused by a blocked tear ducts
Likewise, tear ducts are the tubes through which excess tears drain away. Thus if they become blocked, it can cause your eyes to water.
Compared to in adults, this is usually the result of age, or sometimes inflammation, compression, or trauma.
In a condition when there is a blockage or narrowness, your tears are unable to drain away and will remain in the tear sac. However, if this happens, the tears in the tear sac may become stagnant and a sticky liquid (mucus) may discharge through the tear duct opening into the eye.
Mucocele happens when swelling develops on the side of your nose, next to your eye. Infection can cause a painful abscess to develop just below your eye. Treating it with antibiotics and possibly surgery will help.
Occasionally, the canaliculi (the narrow drainage channels on the inside of your eyes that lead into the tear ducts) can become blocked. It happens by inflammation or scarring due to a viral infection, or other damage, such as trauma.
In addition, the lower eyelid can sometimes turn out (ectropion), causing the openings to the tear ducts to move away from the eye and making it difficult for the tears to reach them.
Blocked tear ducts in babies
For the most part, babies are sometimes born with underdeveloped tear ducts. Particularly the tear ducts can be completely or partially closed (congenital nasolacrimal duct obstruction) and can cause the baby’s eyes to water. Most blocked tear ducts in babies get better on their own before the baby is one year old.
Generally, in some cases, babies with a blocked tear duct can develop eye infections (conjunctivitis). As a result of their eye may be red and have a sticky discharge coming from them. In particular, take your baby to see your doctor if you think they might have an eye infection.
If your baby’s eyes are still watering after the age of one, they may need a small procedure called “probing” to unblock the tear duct. Thus only a very small number of babies with watering eyes require this type of treatment.
Poor tear pump
Generally, to unblock the tear duct, a good blink is very helpful to ensure tears drain properly into the tear duct. People with a weak blink, for example, due to a condition called Bell’s palsy (a type of facial paralysis) have problems with this which contributes to their watery eyes.
For the most part, there are several reasons why you might produce excess tears, some of which we will discuss below.
Generally, excessive tear production (reflex tearing) is usually the result of eye irritation. To wash away the substance irritating your eye (irritant).
Problems that can cause extra tears to include:
- chemical irritants, such as onions or fumes
- an eye infection, such as conjunctivitis
- also an allergy
- an eye injury, such as a piece of grit that becomes lodged in the eye
- an inward-turning eyelid (entropion)
- an outward-turning eyelid (ectropion)
Tears are substances that are water, proteins, and oils. If your tears have an abnormal oil content, they may not be able to spread evenly across your eye. This can result in dry patches developing on your eyes. As a result of it becomes sore and causes extra tears production.
If you have abnormal tears and dry patches, you may have dry eye syndrome, which can cause your eyes to become red, feel gritty, and sometimes water excessively due to reflex tearing.
Blepharitis is a condition where the rims of your eyelids become inflamed, resulting in your eyes stinging or itching. As a result of this irritation can cause reflex tearing. It can also affect how your tears are spread across the surface of your eyes. If your tears are not spread out properly, this can also cause your eyes to water excessively.
Watering eye diagnosis
Your doctor may refer you to an ophthalmologist for an examination. When no obvious reason for your watering eye can be found.
Generally, an ophthalmologist is an eye care specialist. Particularly, they can use special equipment to look for the cause of your watering eye.
Beyond you may not need a specialist examination in an eye condition, such as conjunctivitis or an inward-growing eyelash earlier.
Referral to an ophthalmologist
An ophthalmologist will look for blockages in your tear ducts, using local anesthetic eye drops to help reduce any discomfort.
He may insert a probe through the narrow points on the inside of your eyelids (puncta) and into the narrow drainage channels on the inside of your eyelid (canaliculi) to determine whether there is a blockage. Usually, he may also inject fluid down into your tear duct to see whether it comes out normally.
Another test involves placing a drop of a special dye in each eye. If there is a significant amount remains in your eyes after five minutes of normal blinking, there may be a blockage in the tear duct.
Sometimes you may need scanning of your tear ducts. These can involve either injecting or placing special dyes into the tear ducts and then taking X-rays or other scans to help pinpoint the location of the blockage.
Treatment for watering eyes
Generally, treatment for watering eyes is not always necessary. In brief, having treatment will depend on how severe the problem is and what is causing it.
If irritation is causing your eye to water, treatment will usually focus on removing the source of irritation.
In a condition, if an infection, such as conjunctivitis, is causing watering eyes, your doctor may treat you with a course of antibiotics if they feel that the infection is due to bacteria. If they suspect the condition is due to a virus, you may advise them to wait for a week or so to see if the condition resolves itself.
Excessive watering due to an allergy, a type of medication called an antihistamine will be used to help reduce the inflammation.
In cases where irritation is causing by an inward-growing eyelash or a foreign object, such as a piece of grit, removal of this should be done.
If your lower eyelid turns inwards (entropion) or outwards (ectropion), a minor operation is done under local anesthetic. The most common procedure involves tightening the tendon that holds the outer eyelid in place to give it extra support.
Surgery for blocked tear ducts
As a result of tear ducts are the tubes through which excess tears drain away. If a blocked tear duct is causing watering eyes, it can be treated with surgery.
If, it is up to you whether or not you want treatment. In a condition, if your watering eye is not bothering you, surgery may not be necessary.
Generally, if your eye is sticky or if there is a lump below your eye. In particular, treatment is essential to avoid your eye from becoming infected. If your symptoms are particularly severe and your watering eyes are interfering with your vision for driving, reading, and sports, treatment may be appropriate.
When you have an infection in your tear sac (where excess tears from your eyes drain), treating it with antibiotics and then most likely with surgery will help. Thus if left untreated, the infection could spread to your eye socket.
If Dacryocystorhinostomy (DCR) is a common surgical procedure to remove the blockage of the tear ducts. It involves creating a new channel from the tear sac to the inside of your nose. This channel allows tears to bypass the blocked part of your tear duct.
Before having surgery, an examination of your nose is necessary to check the nasal space and that the lining of the nose is healthy.
In general, the surgery involves removing a very small piece of bone from the side of your nose, allowing the tear sac to drain directly into the nasal cavity. This can be done externally (by making a small incision in the skin on the side of your nose) or endoscopically (from inside the nose, using an endoscope). An endoscope is a narrow, flexible tube with a light at the end). The specialist will remove the bone surgically or by using a laser.
A very thin silicone tube is usually inserted to keep the channel open. After a couple of months, the tube will be removed and the channel should stay open without it.
The DCR procedure usually requires general anesthesia and takes up to an hour to perform.
If the tear duct is not blocked but just narrowed, a thin tube with a small balloon at the end (a balloon catheter) can sometimes be used to widen it.
Most DCR surgery is a day case procedure, which means you can go home the same day. You should follow the instructions at the time of discharge – for example not to blow your nose for 2 weeks after surgery. You may also have to use some eye drops or ointment to prevent infection and inflammation, as well as a nasal spray.
There could be some bruising and swelling around your nose and eye, which should improve over a few days or weeks. You may also experience nosebleeds for a few days. However, these are usually minor and should stop in due course.
If the drainage channels on the inside of your eye (canaliculi) are completely blocked by tears, an operation to drain them may be required, usually involving a small glass tube (called a Lester Jones Tube) being inserted to bypass the blockage and drain the tears.
Treating watering eyes in babies
In babies, watering eyes often improve without the need for treatment by the time the baby is a year old.
Massaging the tear ducts may help to dislodge tears that have collected in the upper part of your baby’s tear duct, as well as encouraging the tear duct to develop. To do this apply light pressure with your first (index) finger and massage from the corner of your baby’s eye towards their nose. Repeat the massage several times a day for a couple of months. Before massaging, wash your hands.
You can also soak a cloth with warm water and hold it against your baby’s eye. This may encourage the tears to drain. If your baby has an eye infection (conjunctivitis), antibiotic eye drops would help.
In 9 out of 10 cases, the tear duct opens by itself before your baby is one year old. However, if your child is over a year old or has repeated infections caused by the blocked tear duct, a procedure may be used to open their tear duct using a probe. This procedure requires a general anesthetic. Dacryocystorhinostomy (DCR) operation is very rare.
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