Tearing (Epiphora)

Tearing, also known as epiphora, is a condition in which there is an overflow of tears onto the face.  Epiphora can develop at any age. It has a bimodal age distribution.  It occurs usually in the first 12 months of life or in the elderly years above the age of 60. The condition may present symptoms in just one or both eyes. Depending on the severity of symptoms, watering eye can sometimes make daily activities such as reading and driving difficult and uncomfortable.

What are the causes of epiphora (watering eye)?
There are two main causes of epiphora – blocked tear ducts or excessive production of tears.

  • Blocked tear ducts – some humans are born with underdeveloped tear ducts. It is not uncommon for newborns to have watery eyes. Generally, this problem goes away within a few weeks as the ducts develop.

The most common cause of watering eyes among adults and older children is blocked ducts, or ducts that are too narrow. Narrowed tear ducts usually become so as a result of swelling (inflammation).

If a patient’s tear ducts are narrowed or blocked their tears will not be able to drain away and will build up in the tear sac. Stagnant tears in the tear sac increase the risk of infection in that area and the eye will produce a sticky liquid, further exacerbating the problem. Infection can also lead to inflammation on the side of the nose, next to the eye.

Narrow drainage channels on the insides of the eyes (canaliculi) can become blocked. This is caused by swelling or scarring.

  • Ocular surface irritation – irritated eyes may produce more tears than normal as the body tries to rinse the irritant away. The following irritants can cause the over-production of tears:

o    Chemicals, such as fumes, pollutants, and even onions
o    Dry eyes
o    Contact lenses- common reason for patients to undergo LASIK
o    Blepharitis
o    Allergic conjunctivitis
o    An injury to the eye,
o    Entropion (inward-growing eyelash)
o    Ectropion – this is when the lower eyelid turns outwards
o    Lagophthalmos or an incomplete blink mechanism

How is epiphora or tearing diagnosed?
With a proper examination an ophthalmologist can usually diagnosis the etiology of excessive tearing, especially if it is due to an anatomical or structural problem.  Further invasive testing may need to be performed to determine if it is due to poor drainage of the nasolacrimal system.

A probe might be inserted into the narrow drainage channels on the inside of the eye (canaliculi) to see whether they are blocked.

Liquid may be inserted into a tear duct to find out whether it comes out of the patient’s nose. If it is found to be blocked, a dye may be injected to find the exact location of the blockage .

What is the treatment?
Treatment options depend on the etiology and severity of the epiphora. In mild cases doctors may recommend just watchful waiting – doing nothing and monitoring the patient’s progress.

•    Treatment for irritation – if the watering eye is caused by infective conjunctivitis the doctor may prefer to wait for a week or so to see if the problem resolves itself without antibiotics.
•    Dry eyes- treatment with artificial tear products, punctal occlusion, or pharmaceutical treatment.
•    Allergic conjunctivitis is the cause the patient may be prescribed an antihistamine or anti-allergy drops, which are effective in bringing down the inflammation.
•    Entropion – an inward-growing eyelash, or some foreign object that lodged in the eye, the doctor will remove it.  Structural entropion is treated with surgery.
•    Ectropion – the eyelid turns outwards – the patient may need to undergo surgery in which the outer eyelid in place is tightened and resumes its natural shape..
•    Blocked tear ducts – surgery which creates a new channel from the tear sac to the inside of the nose may be necessary. This allows the tears to bypass the blocked part of the tear duct. This surgical procedure is called DCR (dacryocystorhinostomy).

If the drainage channels on the inside of the eye (canaliculi) are narrowed, but not entirely blocked, the doctor may use a probe to make them wider. When the canaliculi are completely blocked an operation may be required.
•    Epiphora (watering eye) in babies – in the majority of cases the condition resolves itself on its own within a few weeks.
Sometimes blockages can be dislodged if you gently massage the tear ducts. Apply light pressure with the finger and thumb to the outside of the baby’s nose.